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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)79-83
Number of pages5
JournalAtherosclerosis
Volume316
DOIs
StatePublished - Jan 2021

Keywords

  • CAC area
  • CAC density
  • CAC volume
  • Coronary artery calcium
  • Statins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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