MESA data refine JUPITER-based statin indication
MedWire News: Coronary artery calcium (CAC) scores could be used to identify patients who may benefit most from statin therapy, findings from the Multi-Ethnic Study of Atherosclerosis (MESA) suggest.
Researchers found that there was a graded increase in event rates for coronary heart disease (CHD) with increasing CAC score among MESA participants meeting the entry criteria for the JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin) trial.
The results of JUPITER have led to statins being considered for use in at-risk patients with normal low-density lipoprotein (LDL) cholesterol, but high levels of the inflammatory marker C-reactive protein (CRP).
The researchers said that the results of their study, which were presented at the American Heart Association's (AHA) annual Scientific Sessions in Chicago, Illinois, USA, show that measuring CAC deposits can identify the highest-risk patients from within this group.
Michael Blaha (Johns Hopkins Hospital, Baltimore, Maryland, USA) and colleagues selected 1451 male and female participants (aged 45-84 years and free from clinical cardiovascular disease [CVD] at enrollment) from MESA who met the JUPITER entry criteria.
These required patients to have LDL levels <130 mg/dl (3.36 mmol/l), high sensitivity-CRP levels ≥2 mg/l, no diabetes, and to be receiving no lipid-lowering therapy.
The team measured the MESA participants for presence and burden of CAC, and assigned them to one of three groups: CAC=0, CAC 1-100, and CAC >100. For each group, they compared CHD and CVD event rates and calculated the 5-year number-needed-to-treat (NNT).
Among these participants, the majority had CAC=0 (59%), and experienced an extremely low event rate compared with those with CAC (0.6 vs 10.7 events per 1000 person-years, respectively).
There was a graded increase in coronary events as CAC score increased, with approximately two-thirds of all events occurring in the 15% of participants with CAC >100.
Presence of any CAC was associated with a 9.7-fold increase in risk for a CHD event, while a CAC score ≥100 was associated with a 23.2-fold risk increase.
For participants with a CAC score >100, the estimated 5-year NNTs with statin therapy were 25 and 20 to prevent one CHD and CVD event, respectively, compared with 714 and 177 for those with no CAC.
"Our results tell us that only those with calcium build-up in their arteries have a clear benefit from statin therapy, and those who are otherwise healthy and have no significant calcification should, with their physician, focus on aggressive lifestyle improvements instead of early initiation of statin medications," said Blaha.
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By Nikki Withers