Statin therapy for primary prevention in women: What is the role for coronary artery calcium?

J Clin Lipidol. 2022 Jul-Aug;16(4):376-382. doi: 10.1016/j.jacl.2022.05.001. Epub 2022 May 8.

Abstract

By current guidelines, statin treatment decisions depend on multiple risk factor algorithms (e.g., pooled cohort equations [PCEs]). By available PCEs most older middle-aged women are statin eligible. But several studies cast doubt on reliability of available PCEs for ASCVD risk assessment. An alternative method for risk assessment is a coronary artery calcium (CAC) score. Many older women have zero CAC, which equates to low risk for ASCVD; these women can delay statin therapy for several years before re-scanning. When CAC is 1-99 Agatston units, risk is only borderline high and statin delay also is an option until re-scanning. When CAC is > 100 Agatston units, risk is high enough to warrant a statin. In most women, CAC is the best guide to treatment decisions. In high-risk women (e.g., diabetes and severe hypercholesterolemia), generally are indicated, but CAC can assist in risk assessment, but other risk factors also can aid in treatment decisions.

Keywords: Coronary artery calcium score; Statins; Women.

Publication types

  • Editorial

MeSH terms

  • Aged
  • Calcium
  • Coronary Artery Disease* / drug therapy
  • Coronary Artery Disease* / prevention & control
  • Coronary Vessels / diagnostic imaging
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
  • Middle Aged
  • Primary Prevention / methods
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Vascular Calcification* / prevention & control

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Calcium