MESA: Coronary Artery Calcium Score Could Guide Polypill Preventive Therapy

Results of the Multi-Ethnic Study of Atherosclerosis (MESA) suggest that a coronary artery calcium (CAC) score could be used to identify asymptomatic individuals who would benefit from preventive treatment with a single polypill, according to a study published in the Journal of the American College of Cardiology. This treatment could reduce the risk of cardiovascular disease events and avoid treatment in those unlikely to benefit from polypill therapy.

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The study included 6,814 ethnically diverse asymptomatic individuals between the ages of 45 and 84 who fulfilled inclusion criteria for four previous polypill trials. The investigators scanned the participants with a four-detector CT scanner or electron-beam tomography, stratified them into three groups based on CAC scores and compared the occurrence of cardiovascular disease events within the groups during a median 7.6-year follow-up period.

The researchers found that among participants with a CAC score of 0, the overall rates of cardiovascular disease events were low, ranging from 2.5 to 4.0 events per 1,000 person years. Among participants with a CAC score from 1 to 100, the overall rates of cardiovascular disease events ranged from 3.7 to 6.1 events per 1,000 person years.

Among participants with a CAC score >100, the overall rates of cardiovascular disease events ranged from 15.8 to 18.6 events per 1,000 person years. All of these results remained largely the same after adjustment for age, gender, race, education and MESA site where the participants were recruited.

The researchers assumed a 62-percent reduction in cardiovascular disease events with preventive pharmacologic therapy and estimated the five-year number to treat to prevent one cardiovascular disease event at between 84 and 134 for the group of patients with a CAC score of 0, between 40 and 55 for the group of patients with a CAC score from 1 to 100, and between 19 and 21 for the group of patients with a CAC score >100.

Based on the findings, study investigators suggest that the CAC score has the potential to identify patients most likely to receive net benefit from the polypill. "Such an approach would significantly reduce the number of individuals requiring treatment, thus reducing important side effects and cost but still ensuring treatment to the majority of individuals who are likely to experience [coronary heart disease and cardiovascular disease] events," they said.

An accompanying editorial agrees, stating that refining cardiovascular risk prediction by adding the CAC score to traditional risk scores is an innovative approach to preventing cardiovascular disease events.

Clinical Topics: Noninvasive Imaging, Computed Tomography, Nuclear Imaging

Keywords: Coronary Artery Disease, Follow-Up Studies, Atherosclerosis, Tomography, X-Ray Computed, Cardiovascular Diseases, Risk Factors, Electrons, United States, Calcium


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