Prognostic value of coronary artery calcium score, area, and density among individuals on statin therapy vs. non-users: The coronary artery calcium consortium

Albert D Osei; Mohammadhassan Mirbolouk; Daniel Berman; Matthew J Budoff; Michael D Miedema; Alan Rozanski; John A Rumberger; Leslee Shaw; Mahmoud Al Rifai; Omar Dzaye; Garth N Graham; Maciej Banach; Roger S Blumenthal; Zeina A Dardari; Khurram Nasir; Michael J Blaha

doi:10.1016/j.atherosclerosis.2020.10.009

Prognostic value of coronary artery calcium score, area, and density among individuals on statin therapy vs. non-users: The coronary artery calcium consortium

Atherosclerosis. 2021 Jan:316:79-83. doi: 10.1016/j.atherosclerosis.2020.10.009. Epub 2020 Oct 10.

Authors

Albert D Osei¹, Mohammadhassan Mirbolouk², Daniel Berman³, Matthew J Budoff⁴, Michael D Miedema⁵, Alan Rozanski⁶, John A Rumberger⁷, Leslee Shaw⁸, Mahmoud Al Rifai⁹, Omar Dzaye¹⁰, Garth N Graham¹¹, Maciej Banach¹², Roger S Blumenthal¹⁰, Zeina A Dardari¹⁰, Khurram Nasir¹³, Michael J Blaha¹⁴

Affiliations

¹ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA.
² Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA; Yale University, New Haven, CT, USA.
³ Cedars-Sinai Medical Center, California, USA.
⁴ Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, LA, California, USA.
⁵ Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
⁶ Division of Cardiology, Mount Sinai St. Luke's Hospital, USA.
⁷ Princeton Longevity Center, Princeton, NJ, USA.
⁸ Weill Cornell Medicine, New York, USA.
⁹ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA; Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.
¹⁰ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA.
¹¹ Aetna Foundation, Hartford, CT, USA.
¹² Medical University of Lodz, Poland.
¹³ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA; Houston Methodist Hospital, Houston, TX, USA.
¹⁴ Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, USA. Electronic address: mblaha1@jhmi.edu.

PMID: 33121743
PMCID: PMC7770042
DOI: 10.1016/j.atherosclerosis.2020.10.009

Abstract

Background and aims: Statins do not decrease coronary artery calcium (CAC) and may increase existing calcification or its density. Therefore, we examined the prognostic significance of CAC among statin users at the time of CAC scanning.

Methods: We included 28,025 patients (6151 statin-users) aged 40-75 years from the CAC Consortium. Cox regression models were used to assess the association of CAC with coronary heart disease (CHD) and cardiovascular disease (CVD) mortality. Models were adjusted for traditional CVD risk factors. Additionally, we examined the predictive performance of CAC components including CAC area, volume, and density using an age- and sex-adjusted Cox regression model.

Results: Participants (mean age 53.9 ± 10.3 years, 65.0% male) were followed for median 11.2 years. There were 395 CVD and 182 CHD deaths. One unit increase in log CAC score was associated with increased risk of CVD mortality (hazard ratio (HR), 1.2; 95% CI = 1.1-1.3) and CHD mortality (HR, 1.2; 95% CI = 1.1-1.4)) among statin users. There was a small but significant negative interaction between CAC score and statin use for the prediction of CHD (p-value = 0.036) and CVD mortality (p-value = 0.025). The volume score and CAC area were similarly associated with outcomes in statin users and non-users. Density was associated with CVD and CHD mortality in statin naïve patients, but with neither in statin users.

Conclusion: CAC scoring retains robust risk prediction in statin users, and the changing relationship of CAC density with outcomes may explain the slightly weaker relationship of CAC with outcomes in statin users.

Keywords: CAC area; CAC density; CAC volume; Coronary artery calcium; Statins.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Calcium
Coronary Artery Disease* / diagnostic imaging
Coronary Vessels / diagnostic imaging
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Male
Middle Aged
Prognosis
Risk Assessment
Risk Factors
Vascular Calcification* / diagnostic imaging

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Calcium

Grants and funding

L30 HL110027/HL/NHLBI NIH HHS/United States