根据美国心脏病学会/美国心脏协会胆固醇管理指南，在他汀类药物候选者中进行冠状动脉钙测试的意义：MESA（动脉粥样硬化多民族研究）。

Implications of Coronary Artery Calcium Testing Among Statin Candidates According to American College of Cardiology/American Heart Association Cholesterol Management Guidelines: MESA (Multi-Ethnic Study of Atherosclerosis).

机构信息

Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida; Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.

Center for Clinical and Epidemiological Research and Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Preventive Medicine Centre, Hospital Israelita Albert Einstein, São Paulo, Brazil.

出版信息

J Am Coll Cardiol. 2015 Oct 13;66(15):1657-68. doi: 10.1016/j.jacc.2015.07.066.

DOI:10.1016/j.jacc.2015.07.066

PMID:26449135

Abstract

BACKGROUND

The American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guidelines have significantly broadened the scope of candidates eligible for statin therapy.

OBJECTIVES

This study evaluated the implications of the absence of coronary artery calcium (CAC) in reclassifying patients from a risk stratum in which statins are recommended to one in which they are not.

METHODS

MESA (Multi-Ethnic Study of Atherosclerosis) is a longitudinal study of 6,814 men and women 45 to 84 years of age without clinical atherosclerotic cardiovascular disease (ASCVD) risk at enrollment. We excluded 1,100 participants (16%) on lipid-lowering medication, 87 (1.3%) without low-density lipoprotein levels, 26 (0.4%) with missing risk factors for calculation of 10-year risk of ASCVD, 633 (9%) >75 years of age, and 209 (3%) with low-density lipoprotein <70 mg/dl from the analysis.

RESULTS

The study population consisted of 4,758 participants (age 59 ± 9 years; 47% males). A total of 247 (5.2%) ASCVD and 155 (3.3%) hard coronary heart disease events occurred over a median (interquartile range) follow-up of 10.3 (9.7 to 10.8) years. The new ACC/AHA guidelines recommended 2,377 (50%) MESA participants for moderate- to high-intensity statins; the majority (77%) was eligible because of a 10-year estimated ASCVD risk ≥7.5%. Of those recommended statins, 41% had CAC = 0 and had 5.2 ASCVD events/1,000 person-years. Among 589 participants (12%) considered for moderate-intensity statin, 338 (57%) had a CAC = 0, with an ASCVD event rate of 1.5 per 1,000 person-years. Of participants eligible (recommended or considered) for statins, 44% (1,316 of 2,966) had CAC = 0 at baseline and an observed 10-year ASCVD event rate of 4.2 per 1,000 person-years.

CONCLUSIONS

Significant ASCVD risk heterogeneity exists among those eligible for statins according to the new guidelines. The absence of CAC reclassifies approximately one-half of candidates as not eligible for statin therapy.

摘要

背景

美国心脏病学会（ACC）/美国心脏协会（AHA）胆固醇管理指南大大拓宽了适合他汀类药物治疗的候选人群范围。

目的

本研究评估了冠状动脉钙（CAC）缺失对将患者从建议使用他汀类药物的风险分层重新分类为不建议使用他汀类药物的风险分层的影响。

方法

MESA（动脉粥样硬化多民族研究）是一项针对 6814 名年龄在 45 至 84 岁之间、无临床动脉粥样硬化性心血管疾病（ASCVD）风险的男性和女性的纵向研究。我们排除了 1100 名（16%）正在服用降脂药物的参与者、87 名（1.3%）没有低密度脂蛋白水平的参与者、26 名（0.4%）因计算 10 年 ASCVD 风险而缺少危险因素的参与者、633 名（9%）年龄>75 岁的参与者和 209 名（3%）低密度脂蛋白<70mg/dl 的参与者。

结果

研究人群由 4758 名参与者（年龄 59±9 岁；47%为男性）组成。中位（四分位距）随访 10.3（9.7 至 10.8）年后，共有 247 名（5.2%）发生 ASCVD 和 155 名（3.3%）发生硬冠状动脉心脏病事件。新的 ACC/AHA 指南建议 2377 名（50%）MESA 参与者使用中等强度至高强度的他汀类药物；大多数（77%）因 10 年估计 ASCVD 风险≥7.5%而符合条件。在建议使用他汀类药物的患者中，有 41%的患者 CAC=0，每 1000 人年有 5.2 例 ASCVD 事件。在 589 名（12%）被认为需要中等强度他汀类药物的患者中，有 338 名（57%）CAC=0，每 1000 人年有 1.5 例 ASCVD 事件。在符合（建议或考虑）他汀类药物治疗的患者中，有 44%（2966 名中的 1316 名）在基线时 CAC=0，观察到每 1000 人年有 4.2 例 ASCVD 事件。