Use of the Coronary Artery Calcium Score in Discussion of Initiation of Statin Therapy
Use of the Coronary Artery Calcium Score in Discussion of Initiation of Statin Therapy in Primary Prevention.
This is the theme of a new US study, carried out by Erin D. Michos,MD, MPH, Michael J. Blaha, MD, MPH, Roger S. Blumenthal, MD,Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
Results from the study were publishe in Mayo Clinic Procedings Journal.
For nearly 2 decades, clinical decisions for lipid-lowering pharmacotherapy in primary prevention have been predicated on an initial assessment of global absolute risk.
More recently, the 2013 ACC/AHA risk assessment guidelines endorse risk factor screening every 4 to 6 years for those aged 20 to 79 years and application of the race- and sex-specific Pooled Cohort Equations (PCE) in asymptomatic adults aged 40 to 79 years to estimate 10-year risk for a first “hard” ASCVD event (myocardial infarction and stroke).
Guidelines differ in relation to the risk threshold for initiation and the intensity of statin treatment. The key concept of the clinician-patient risk discussion introduced in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines is a process that addresses the potential for ASCVD risk reduction with statin treatment, potential for adverse treatment effects, patient preferences, encouragement of heart-healthy lifestyle, and management of other risk factors
The authors in the study recommend risk estimation using the PCE is a helpful starting point in the clinician-patient risk discussion for preventive therapy. As part of shared decision making, guidelines support offering CAC testing for advanced risk assessment in a wide variety of circumstances when either the patient or the clinician feel uncertain about whether to initiate (or intensify) lipid-lowering therapy.