Calcified Coronary Plaque and Preventive Therapies

Study Questions:

What are the odds of initiation or continuation of pharmacological and lifestyle preventive therapies in patients with non-zero versus zero coronary artery calcium (CAC) score detected on cardiac computed tomography?

Methods:

The authors searched PubMed, EMBASE (Excerpta Medica database), Web of Science, Cochrane CENTRAL (Cochrane central register of controlled trials), ClinicalTrials.gov, and the International Clinical Trials Registry Platform for studies evaluating the association of CAC scores with downstream pharmacological or lifestyle interventions for prevention of cardiovascular disease. Pooled odds ratios (ORs) of downstream interventions were obtained using the DerSimonian and Laird random-effects model.

Results:

A total of 54 full-text papers, six studies (11,256 participants, mean follow-up time: 1.6-6.0 years) were included. The largest cohort of 6,184 participants was from MESA with mean follow-up of 1.6 years. In individuals with non-zero CAC versus zero CAC scores, pooled estimates of the odds of aspirin initiation was 2.6, for lipid-lowering medication 2.9, blood pressure–lowering medication initiation 1.9; for continuation of lipid-lowering medication 2.3, increase in exercise 1.8, and dietary change 1.9, but not for aspirin or blood pressure–lowering medication continuation. When assessed within individual studies, these findings remained significant after adjustment for baseline patient characteristics and cardiovascular risk factors.

Conclusions:

This systematic review and meta-analysis suggests that non-zero CAC score, identifying calcified coronary plaque, significantly increases the likelihood of initiation or continuation of pharmacological and lifestyle therapies for the prevention of cardiovascular disease.

Perspective:

Guidelines suggest obtaining a CAC score in men and women with low and intermediate 10-year risk for cardiovascular events (CVEs) to help decide use of statins. But the true value will require a controlled study to determine the relative benefit of the range of coronary calcium scores in consideration of the wide range of variables associated with CVEs, and considering the recent literature, the implications of the calcium density score in addition to the Agatston score, calcium volume, and other measures.

Clinical Topics: Dyslipidemia, Noninvasive Imaging, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Aspirin, Blood Pressure, Cardiovascular Diseases, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Life Style, Lipids, Pharmacology, Plaque, Atherosclerotic, Primary Prevention, Risk Factors, Tomography, Vascular Diseases


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