Statin eligibility and cardiovascular risk burden assessed by coronary artery calcium score: Comparing the two guidelines in a large Korean cohort

• Published in: Atherosclerosis Vol. 240; no. 1; pp. 242 - 249
• Main Authors: Rhee, Eun-Jung, Park, Se Eun, Oh, Hyung Geun, Park, Cheol-Young, Oh, Ki-Won, Park, Sung-Woo, Blankstein, Ron, Plutzky, Jorge, Lee, Won-Young
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.05.2015
• Subjects: Adult; Aged; Atherosclerosis; Cardiovascular; Chi-Square Distribution; Coronary Angiography - methods; Coronary artery calcification (CAC); Coronary Artery Disease - blood; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - drug therapy; Coronary Artery Disease - epidemiology; Cross-Sectional Studies; Decision Support Techniques; Dyslipidemias - blood; Dyslipidemias - diagnosis; Dyslipidemias - drug therapy; Dyslipidemias - epidemiology; Eligibility Determination - standards; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Logistic Models; Male; Middle Aged; Multidetector Computed Tomography; Multivariate Analysis; Odds Ratio; Patient Selection; Pooled Cohort Equation; Practice Guidelines as Topic - standards; Predictive Value of Tests; Republic of Korea - epidemiology; Risk Assessment; Risk Factors; Severity of Illness Index; Statin; Vascular Calcification - blood; Vascular Calcification - diagnostic imaging; Vascular Calcification - drug therapy; Vascular Calcification - epidemiology; Coronary artery calcification (CAC); Statin; Pooled Cohort Equation; Atherosclerosis
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2015.03.006

To investigate the statin eligibility and the predictabilities for cardiovascular disease between AHA/ACC and ATPIII guidelines, comparing those results to concomitant coronary artery calcium scores (CACS) in a large cohort of Korean individuals who met statin-eligibility criteria. Among 19,920 participants in a health screening program, eligibility for statin treatment was assessed by the two guidelines. The presence and extent of coronary artery calcification (CAC) was measured by multi-detector computed tomography and compared among the various groups defined by the two guidelines. Applying the new ACC/AHA guideline to the health screening cohort increased the statin-eligible population from 18.7% (as defined by ATP III) to 21.7%. Statin-eligible subjects as defined only by ACC/AHA guideline manifested a higher proportion of subjects with CAC compared with those meeting only ATP-III criteria even after adjustment for age and sex (47.1 vs. 33.8%, p < 0.01). Statin-eligible subjects as defined by ACC/AHA guideline showed higher odds ratio for the presence of CACS>0 compared with those meeting ATP-III criteria {3.493 (3.245∼3.759) vs. 2.865 (2.653∼3.094)}, which was attenuated after adjusted for age and sex. In this large Korean cohort, more subjects would have qualified for statin initiation under the new ACC/AHA guideline as compared with the proportion recommended for statin treatment by ATP III guideline. Among statin-eligible Korean health screening subjects, the new ACC/AHA guideline identified a greater extent of atherosclerosis as assessed by CACS as compared to ATP III guideline assessment. •Applying the new ACC/AHA guideline increased the statin-eligible population from 18.7% to 21.7% as defined by ATP III in Korean health screening cohort.•Statin-eligible subjects as defined by ACC/AHA guideline manifested a higher proportion of subjects with CAC compared with those meeting ATP-III criteria for statin treatment.•ACC/AHA guideline demonstrated better prediction for CAC compared with ATP III guideline with higher odds ratio for cardiovascular disease.