OBJECTIVES: The JUPITER trial showed that some patients with LDL-cholesterol concentrations less than 3·37 mmol/L (<130 mg/dL) and high-sensitivity C-reactive protein (hsCRP) concentrations of 2 mg/L or more benefit from treatment with rosuvastatin, although absolute rates of cardiovascular events were low. In a population eligible for JUPITER, we established whether coronary artery calcium (CAC) might further stratify risk; additionally we compared hsCRP with CAC for risk prediction across the range of low and high hsCRP values.
METHODS: 950 participants from the Multi-Ethnic Study of Atheroslcerosis (MESA) met all criteria for JUPITER entry. We compared coronary heart disease and cardiovascular disease event rates and multivariable-adjusted hazard ratios after stratifying by burden of CAC (scores of 0, 1—100, or >100). We calculated 5-year number needed to treat (NNT) by applying the benefit recorded in JUPITER to the event rates within each CAC strata.
RESULTS: Median follow-up was 5·8 years (IQR 5·7—5·9). 444 (47%) patients in the MESA JUPITER population had CAC scores of 0 and, in this group, rates of coronary heart disease events were 0·8 per 1000 person-years. 74% of all coronary events were in the 239 (25%) of participants with CAC scores of more than 100 (20·2 per 1000 person-years). For coronary heart disease, the predicted 5-year NNT was 549 for CAC score 0, 94 for scores 1—100, and 24 for scores greater than 100. For cardiovascular disease, the NNT was 124, 54, and 19. In the total study population, presence of CAC was associated with a hazard ratio of 4·29 (95% CI 1·99—9·25) for coronary heart disease, and of 2·57 (1·48—4·48) for cardiovascular disease. hsCRP was not associated with either disease after multivariable adjustment.
CONCLUSIONS: CAC seems to further stratify risk in patients eligible for JUPITER, and could be used to target subgroups of patients who are expected to derive the most, and the least, absolute benefit from statin treatment. Focusing of treatment on the subset of individuals with measurable atherosclerosis could allow for more appropriate allocation of resources.
Lady Davis Carmel Medical Center
Latest posts by Ronen Rubinshtein (see all)
- Anatomic Characteristics and Outcome of Adults With Coronary Arteries Arising From an Anomalous Location Detected With Coronary Computed Tomography Angiography - October 2, 2014
- Fractional Flow Reserve Calculation From 3-Dimensional Quantitative Coronary Angiography and TIMI Frame Count: A Fast Computer Model to Quantify the Functional Significance of Moderately Obstructed Coronary Arteries - September 4, 2014
- Iterative Model Reconstruction: Improved Image Quality of Low-Tube-Voltage Prospective ECG-Gated Coronary CT Angiography Images at 256-Slice CT - June 1, 2014