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Reduction of MI and Mortality With Statins in Nonobstructive CAD
Quick Takes
- Among patients with nonobstructive CAD, greater coronary artery calcium scores (CACS) were associated with increased MI and all-cause mortality.
- Statin therapy was associated with reduced cardiovascular events across the spectrum of CACS.
Study Questions:
Is statin therapy associated with a lower risk for cardiovascular events among systematic adults with no obstructive coronary artery disease (CAD)?
Methods:
Adults who had received coronary computed tomography (CT) testing were identified using data from the WDHR-CT (Western Denmark Heart Registry Cardiac Computed Tomography Registry), which includes all CT angiography testing in western Denmark since 2008. Adults with suspected CAD in western Denmark from 2008-2017, but without obstructive CAD (<50% coronary stenoses), comprised the study population of interest. Statin use in this population was obtained through the Danish National Prescription Registry. The primary outcome of interest was cardiovascular events obtained through the Danish National Patient Registry, which contains validated records of all in-hospital and outpatient visits, including diagnosis and procedure codes.
Results:
A total of 33,552 patients (median age 56 years, 58% female) were identified, of which 19,669 met the definition of no CAD, and 13,883 met the definition of nonobstructive CAD. The median follow-up was 3.5 years. The absolute risk of the combined endpoint of myocardial infarction (MI) or all-cause mortality was significantly associated with the CAD burden with an event rate of 1,000 patient-years of 4.13 (95% confidence interval [CI], 3.69-4.61) among adults with no CAD. Among those with mild CAD (coronary artery calcium score [CACS] 0-99), the event rate was 7.74 (95% CI, 6.88-8.71). For adults with moderate CACS (100-399), the event rate increased to 13.72 (95% CI, 11.61-16.23). For adults with nonobstructive CAD but a CACS ≥400, the event rate was 32.47 (95% CI, 26.25-40.16). Statin therapy was associated with a multivariable adjusted hazard ratio for MI and death of 0.52 (95% CI, 0.36-0.75) in no, 0.44 (95% CI, 0.32-0.62) in mild, 0.51 (95% CI, 0.34-0.75) in moderate, and 0.52 (95% CI, 0.32-0.86) in severe nonobstructive CAD. The estimated numbers needed to treat to prevent the primary endpoint were 92 (95% CI, 61-182) in no, 36 (95% CI, 26-58) in mild, 24 (95% CI, 15-61) in moderate, and 13 (95% CI, 7-86) in severe nonobstructive CAD.
Conclusions:
The investigators concluded that the risk of MI and all-cause mortality in patients without obstructive CAD is directly associated with the CAD burden. Statin therapy is associated with a reduction of MI and all-cause death across the spectrum of CAD, with the absolute benefit of treatment directionally proportional with the CAD burden.
Perspective:
These observational data support the use of statin therapy among adults with cardiac symptoms, but no obstructive CAD, as observed on coronary CT. Furthermore, the benefits were greatest among those with the highest CAD burden.
Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Nonstatins, Novel Agents, Statins, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging
Keywords: Coronary Angiography, Coronary Artery Disease, Coronary Stenosis, Diagnostic Imaging, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Outpatients, Plaque, Atherosclerotic, Primary Prevention, Tomography, X-Ray Computed
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