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Published on: September 22, 2023
The Multi-Ethnic Study of Atherosclerosis-Calcium Score Improves Statin Treatment Allocation in Asymptomatic Adults
Gadi Shlomai1,2,3, Joseph Shemesh3,4, Shlomo Segev5
1Department of Internal Medicine D and Hypertension Unit, Chaim Sheba Medical Center, Ramat Gan, Israel.
Insights
The MESA-C score, incorporating coronary artery calcium, better identifies cardiovascular risk in asymptomatic adults than traditional methods. This improves statin therapy allocation and patient survival predictions.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Imaging
Background:
- Current cardiovascular (CV) risk categorization broadens statin therapy indications.
- Coronary artery calcium (CAC) scoring aids in identifying individuals most likely to benefit from primary prevention with statin therapy.
- The Multi-Ethnic Study of Atherosclerosis-Calcium (MESA-C) score integrates CAC for enhanced CV risk stratification.
Purpose of the Study:
- To determine if the MESA-C score improves statin treatment allocation in asymptomatic adults.
- To analyze patient survival rates based on MESA-C risk score calculations.
- To compare the discriminative ability of MESA-C with traditional risk scores.
Main Methods:
- Retrospective analysis of 632 asymptomatic adults without prior coronary artery disease or stroke.
- Calculation of both Pooled Cohort Equations (PCE) and MESA-C risk scores for each participant.
- Classification of subjects into moderate/high (≥7.5%) or borderline/low (<7.5%) 10-year CV risk categories.
Main Results:
- The MESA-C score demonstrated improved CV risk discrimination (C-statistic 0.770 vs. 0.653 for PCE).
- Individuals with MESA-C scores below 7.5% showed favorable outcomes, even if PCE indicated higher risk.
- MESA-C reclassified 84% of borderline-risk individuals (PCE 5-7.5%) into lower or higher risk categories, impacting treatment decisions.
- Low MESA-C scores correlated with the highest survival rates, while high MESA-C scores correlated with the lowest, irrespective of PCE.
Conclusions:
- The MESA-C score enhances cardiovascular risk discrimination and optimizes statin therapy allocation in asymptomatic individuals.
- Both MESA-C and PCE scores are crucial for precise patient survival estimations.
- CAC scoring via MESA-C provides valuable incremental information for preventive cardiology.
Background:
The current categorization of cardiovascular (CV) risk broadens the indications for statin therapy. Coronary artery calcium (CAC) identifies those who are most likely to benefit from primary prevention with statin therapy. The multi-ethnic study of atherosclerosis-calcium (MESA-C) includes CAC for CV risk stratification.
Objective:
We aimed to establish whether the MESA-C score improves allocation to statin treatment in a cohort of asymptomatic adults. We also analyzed patient survival according to their risk score calculation.
Design:
A retrospective analysis of asymptomatic adults.
Participants:
A total of 632 consecutive subjects free of coronary artery disease (CAD) and/or stroke, mean age 56 ± 7 years, 84% male, underwent clinical evaluations and CAC measurements.
Main Measures:
PCE and MESA-C risk scores were calculated for each subject. According to the 10-year risk for CV events, subjects were classified into moderate and high CV risk (≥7.5%) for whom a statin is clearly indicated, or borderline and low CV risk (<7.5%).
Key Results:
During mean follow-up of 6.5 ± 3.3 years, 52 subjects experienced their first CV event. Those with a MESA-C risk score < 7.5% had favorable outcomes even when the PCE indicated a risk of ≥ 7.5%. The MESA-C score improved the discrimination of CV risk with the ROC curves C-statistics increasing from 0.653 for the PCE to 0.770 for the MESA-C. Of those, 84% (99/118) with borderline CV risk (5-7.5%) according to the PCE score, were reallocated by the MESA-C score into a higher (≥7.5%) or lower (<5%) CV risk category. Furthermore, subjects with low MESA-C scores had the highest survival rate regardless of the PCE risk, while those with high MESA-C risks had the lowest survival rate regardless of the PCE risk.
Conclusion:
In asymptomatic subjects, the MESA-C score improves allocation to statin treatment and CV risk discrimination, while both scores are essential for more precise survival estimations.
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