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Coronary Artery Calcium to Guide a Personalized Risk-Based Approach to Initiation and Intensification of

John W McEvoy1, Seth S Martin2, Zeina A Dardari2

  • 1From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., S.S.M., Z.A.D., W.S.P., K.N., R.S.B., M.J.Blaha); Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (M.D.M.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston-Salem, NC (J.Y.); Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.J.Budoff); Department of Epidemiology, Colorado School of Public Health, Aurora (D.C.G.); Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle (B.M.P.); and Center for Healthcare Advancement and Outcomes and Miami Cardiac and Vascular Institute, Baptist Health South Florida (K.N.). jmcevoy1@jhmi.edu.

Circulation
|November 25, 2016
PubMed
Summary

Coronary artery calcium (CAC) imaging can help personalize systolic blood pressure (SBP) treatment intensity. CAC, combined with atherosclerotic cardiovascular disease (ASCVD) risk, guides SBP goals, especially for those with prehypertension or mild hypertension.

Keywords:
antihypertensive therapycardiovascular disease riskcoronary artery calciumsystolic blood pressure

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Area of Science:

  • Cardiology
  • Preventive Medicine
  • Medical Imaging

Background:

  • Personalizing systolic blood pressure (SBP) treatment goals using atherosclerotic cardiovascular disease (ASCVD) risk is increasingly important.
  • Coronary artery calcium (CAC) imaging may offer further guidance on antihypertensive treatment intensity.

Purpose of the Study:

  • To investigate if CAC imaging can refine treatment intensity allocation for SBP.
  • To assess the role of CAC in stratifying cardiovascular risk beyond traditional ASCVD risk scores.

Main Methods:

  • Analysis of 3733 Multi-Ethnic Study of Atherosclerosis (MESA) participants with SBP 120-179 mm Hg.
  • Stratification by SBP, 10-year ASCVD risk, and CAC score (0, 1-100, >100).
  • Comparison of multivariable-adjusted hazard ratios for ASCVD or heart failure, and estimation of number-needed-to-treat for intensive SBP goals.

Main Results:

  • In individuals with SBP <160 mm Hg, CAC significantly stratified event risk, particularly when ASCVD risk was <15%.
  • For example, among those with ASCVD risk <15% and SBP 120-159 mm Hg, higher CAC scores correlated with increased hazard ratios for events.
  • No clear association between CAC and events was observed when SBP was 160-179 mm Hg, irrespective of ASCVD risk.

Conclusions:

  • Combined CAC imaging and ASCVD risk assessment can guide personalized SBP treatment goals (e.g., 140 vs. 120 mm Hg).
  • This approach is particularly beneficial for adults with 5%-15% estimated ASCVD risk and prehypertension or mild hypertension.
  • CAC imaging adds value in risk stratification for individuals not meeting higher ASCVD risk thresholds.