Atherosclerotic cardiovascular disease events among statin eligible individuals with and without long-term healthy arterial aging.

Abstract

BACKGROUND AND AIMS:

A large proportion of statin eligible candidates have a baseline absence of coronary artery calcium (CAC) and low 10-year atherosclerotic cardiovascular disease (ASCVD) risk. We sought to determine the proportion of statin eligible individuals who had long-term healthy arterial aging (persistent CAC = 0) and their examined 15-year ASCVD outcomes.

METHODS:

We included 561 statin eligible candidates from the Multi-Ethnic Study of Atherosclerosis who were not on statin therapy with CAC = 0 at Visit 1 (2000-02) and underwent a subsequent CAC scan at Visit 5 (2010-11). Adjusted Cox proportional hazards regression assessed the association between persistent CAC = 0 and ASCVD events over 15.9 years.

RESULTS:

Participants were on average 61.7 years old, 50% were women, and 43% maintained long-term CAC = 0. Individuals with an LDL-C ≥190 mg/dL (54%) and those with an ASCVD risk ≥20% (33%) had the highest and lowest proportion of persistent CAC = 0, respectively. There were 57 ASCVD events, and 15-year ASCVD event rates were low for individuals with and without healthy arterial aging (4.3 versus 8.6 per 1,000 persons-years), but the 10-year number needed to treat to prevent one ASCVD event differed by more than two fold (117 versus 54). In multivariable modeling, persistent CAC = 0 conferred a 51% lower risk of ASCVD compared to those with incident CAC (HR = 0.49, 95% CI: 0.27-0.90, p=0.02).

CONCLUSIONS:

More than 40% of statin eligible individuals with baseline CAC = 0 had long-term healthy arterial aging. Statin eligible candidates with persistent CAC = 0 had a very low 15-year ASCVD risk, suggesting that statin therapy may be of limited benefit among this group of individuals.

• Authors: Alexander C Razavi, Tanika N Kelly, Matthew J Budoff, Lydia A Bazzano, Jiang He, Camilo Fernandez, Joao Lima, Khurram Nasir, Roger S Blumenthal, Michael J Blaha, Seamus P Whelton
• Journal: Atherosclerosis (Atherosclerosis) Vol. 326 Pg. 56-62 (06 2021) ISSN: 1879-1484 [Electronic] Ireland
• PMID: 33824003 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2021 Elsevier B.V. All rights reserved.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Aging
• Atherosclerosis
• Cardiovascular Diseases
• Coronary Artery Disease
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Middle Aged
• Risk Assessment
• Risk Factors
• Vascular Calcification