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A Simple Disease-Guided Approach to Personalize ACC/AHA-Recommended Statin Allocation in Elderly People: The BioImage

Martin Bødtker Mortensen1, Valentin Fuster2, Pieter Muntendam3

  • 1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

Journal of the American College of Cardiology
|August 27, 2016
PubMed

Insights

Personalizing statin therapy using imaging for subclinical atherosclerosis improves risk prediction. Noninvasive assessment of coronary artery calcium (CAC) or carotid plaque burden (cPB) helps identify individuals who may not benefit from statins, avoiding unnecessary medication.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Medical Imaging

Background:

  • Current guidelines recommend statin therapy for primary prevention of atherosclerotic cardiovascular disease (ASCVD) based on 10-year risk.
  • Age alone causes many individuals to meet eligibility criteria for risk-based statin therapy.

Purpose of the Study:

  • To personalize ASCVD risk stratification for statin eligibility.
  • To evaluate the utility of noninvasive subclinical atherosclerosis assessment in refining statin recommendations.

Main Methods:

  • The BioImage study analyzed 5,805 participants without known ASCVD.
  • Participants with ≥7.5% 10-year ASCVD risk were reclassified based on coronary artery calcium (CAC) or carotid plaque burden (cPB) imaging.
  • Intermediate-risk individuals were also reclassified based on CAC or cPB scores.

Main Results:

  • High percentage (86%) of participants qualified for statins by ACC/AHA guidelines, with low specificity (15%).
  • Absence of CAC or cPB was common and associated with low event rates.
  • CAC-guided reclassification significantly improved specificity for coronary heart disease events (22%) with minimal sensitivity loss, yielding a positive net reclassification index (NRI).
  • cPB-guided reclassification also improved specificity with a minor impact on sensitivity, showing a positive NRI.

Conclusions:

  • Withholding statins in individuals with no detectable CAC or carotid plaque could prevent unnecessary medication in many elderly patients.
  • An individualized, disease-guided approach using imaging is simple and feasible for clinical practice.
Abstract

Keywords:
cardiovascular diseasecarotid plaquecoronary calciumprimary preventionrisk assessment

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