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Neutralizing the Adverse Prognosis of Coronary Artery Calcium

      Abstract

      Objectives

      To report and compare the outcomes and survival of patients with abnormal computed tomography–derived coronary artery calcium (CT-CAC) scores undergoing aggressive medical treatment at a cardiac prevention clinic.

      Patients and Methods

      We conducted a retrospective analysis of 849 patients with intermediate risk based on the Framingham risk score and an abnormal CT-CAC score who were aggressively treated in a preventive cardiology risk factor modification program from June 23, 2000, to September 1, 2012. The primary outcome was a composite end point of myocardial infarction, resuscitated cardiac arrest, revascularization, and cardiovascular death. The effect of the CT-CAC subgroup on major adverse coronary heart disease events (MACEs) was evaluated by calculating hazard ratios with Cox proportional hazards regression modeling. The Centers for Disease Control and Prevention Wonder database was used to identify age- and sex-matched controls from the general population of Kansas and Missouri.

      Results

      The mean age of the study patients was 65.4 years (58.4% men [496]). The median follow-up was 58 months, and the mean CT-CAC score was 336 Agatston units. Thirty-four patients (4.0%) reached the primary end point, including 4 deaths. The adjusted 10-year mortality rates were similar in the study group and control group (9.3 vs 10.6; P=.80). After adjustment, a CT-CAC score greater than 400 Agatston units correlated with a higher risk of MACEs (hazard ratio, 3.55; P=.01).

      Conclusion

      These results suggest that intermediate-risk patients with abnormal CT-CAC scores when treated with intensive risk factor reduction have lower rates of MACEs than predicted by the Framingham risk score and the presence of coronary artery calcium.

      Abbreviations and Acronyms:

      CHD (coronary heart disease), CT-CAC (computed tomography–derived coronary artery calcium), CWC (Cardio Wellness Clinic), DM (diabetes mellitus), FRS (Framingham risk score), HDL-C (high-density lipoprotein cholesterol), HR (hazard ratio), LDL-C (low-density lipoprotein cholesterol), MACE (major adverse CHD event), SHAPE (Screening for Heart Attack Prevention and Education)
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      References

        • Ford E.S.
        • Capewell S.
        Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates.
        J Am Coll Cardiol. 2007; 50: 2128-2132
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • et al.
        • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        Heart disease and stroke statistics–2013 update: a report from the American Heart Association.
        Circulation. 2013; 127: e6-e245
        • Detrano R.
        • Guerci A.D.
        • Carr J.J.
        • et al.
        Coronary calcium as a predictor of coronary events in four racial or ethnic groups.
        N Engl J Med. 2008; 358: 1336-1345
        • Kavousi M.
        • Elias-Smale S.
        • Rutten J.H.
        • et al.
        Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study.
        Ann Intern Med. 2012; 156: 438-444
        • Yeboah J.
        • McClelland R.L.
        • Polonsky T.S.
        • et al.
        Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals.
        JAMA. 2012; 308: 788-795
        • Ahmadi N.
        • Hajsadeghi F.
        • Blumenthal R.S.
        • Budoff M.J.
        • Stone G.W.
        • Ebrahimi R.
        Mortality in individuals without known coronary artery disease but with discordance between the Framingham risk score and coronary artery calcium.
        Am J Cardiol. 2011; 107: 799-804
        • Das S.
        • O'Keefe J.H.
        Behavioral cardiology: recognizing and addressing the profound impact of psychosocial stress on cardiovascular health.
        Curr Hypertens Rep. 2008; 10: 374-381
        • Naghavi M.
        • Falk E.
        • Hecht H.S.
        • et al.
        From vulnerable plaque to vulnerable patient–Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report.
        Am J Cardiol. 2006; 98: 2H-15H
        • Centers for Disease Control and Prevention
        About Underlying Cause of Death, 1999-2009.
        National Center for Health Statistics, Hyattsville, MD2010 (Accessed September 12, 2012)
        • Boden W.E.
        • O'Rourke R.A.
        • Teo K.K.
        • et al.
        Optimal medical therapy with or without PCI for stable coronary disease.
        N Engl J Med. 2007; 356: 1503-1516
        • Nasir K.
        • McClelland R.L.
        • Blumenthal R.S.
        • et al.
        Coronary artery calcium in relation to initiation and continuation of cardiovascular preventive medications: The Multi-Ethnic Study of Atherosclerosis (MESA).
        Circ Cardiovasc Qual Outcomes. 2010; 3: 228-235
        • Budoff M.J.
        • Lane K.L.
        • Bakhsheshi H.
        • et al.
        Rates of progression of coronary calcium by electron beam tomography.
        Am J Cardiol. 2000; 86: 8-11
        • Arad Y.
        • Spadaro L.A.
        • Roth M.
        • Newstein D.
        • Guerci A.D.
        Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin E: the St. Francis Heart Study randomized clinical trial.
        J Am Coll Cardiol. 2005; 46: 166-172
        • Reilly S.D.
        • Litovsky S.H.
        • Steinkampf M.P.
        • Caulfield J.B.
        Statins improve human coronary atherosclerotic plaque morphology.
        Tex Heart Inst J. 2008; 35: 99-103
        • Koshy S.
        • Thompson R.C.
        Review of radiation reduction strategies in clinical cardiovascular imaging.
        Cardiol Rev. 2012; 20: 139-144
        • Voros S.
        • Rivera J.J.
        • Berman D.S.
        • et al.
        Guideline for minimizing radiation exposure during acquisition of coronary artery calcium scans with the use of multidetector computed tomography: a report by the Society for Atherosclerosis Imaging and Prevention Tomographic Imaging and Prevention Councils in collaboration with the Society of Cardiovascular Computed Tomography.
        J Cardiovasc Comput Tomogr. 2011; 5: 75-83
        • Bybee K.A.
        • Lee J.
        • Markiewicz R.
        • et al.
        Diagnostic and clinical benefit of combined coronary calcium and perfusion assessment in patients undergoing PET/CT myocardial perfusion stress imaging.
        J Nucl Cardiol. 2010; 17: 188-196
        • Greenland P.
        • Alpert J.S.
        • Beller G.A.
        • et al.
        2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2010; 122: e584-e636
        • Machaalany J.
        • Yam Y.
        • Ruddy T.D.
        • et al.
        Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography.
        J Am Coll Cardiol. 2009; 54: 1533-1541