Han Donghee, Ó Hartaigh Bríain, Lee Ji Hyun, Rizvi Asim, Park Hyo Eun, Choi Su Yeon, Sung Jidong, Chang Hyuk Jae
Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, Korea.
Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
Yonsei Med J. 2017 Jan;58(1):82-89. doi: 10.3349/ymj.2017.58.1.82.
The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guidelines advocate the use of statin treatment for prevention of cardiovascular disease. We aimed to assess the usefulness of coronary artery calcium (CAC) for stratifying potential candidates of statin use among asymptomatic Korean individuals.
A total of 31375 subjects who underwent CAC scoring as part of a general health examination were enrolled in the current study. Statin eligibility was categorized as statin recommended (SR), considered (SC), and not recommended (SN) according to ACC/AHA guidelines. Cox regression analysis was employed to estimate hazard ratios (HR) with 95% confidential intervals (CI) after stratifying the subjects according to CAC scores of 0, 1-100, and >100. Number needed to treat (NNT) to prevent one mortality event during study follow up was calculated for each group.
Mean age was 54.4±7.5 years, and 76.3% were male. During a 5-year median follow-up (interquartile range; 3-7), there were 251 (0.8%) deaths from all-causes. A CAC >100 was independently associated with mortality across each statin group after adjusting for cardiac risk factors (e.g., SR: HR, 1.60; 95% CI, 1.07-2.38; SC: HR, 2.98; 95% CI, 1.09-8.13, and SN: HR, 3.14; 95% CI, 1.08-9.17). Notably, patients with CAC >100 displayed a lower NNT in comparison to the absence of CAC or CAC 1-100 in SC and SN groups.
In Korean asymptomatic individuals, CAC scoring might prove useful for reclassifying patient eligibility for receiving statin therapy based on updated 2013 ACC/AHA guidelines.
2013年美国心脏病学会（ACC）/美国心脏协会（AHA）胆固醇管理指南提倡使用他汀类药物治疗来预防心血管疾病。我们旨在评估冠状动脉钙化（CAC）在对无症状韩国人群中他汀类药物潜在使用者进行分层方面的作用。
本研究纳入了31375名作为一般健康检查一部分接受了CAC评分的受试者。根据ACC/AHA指南，他汀类药物适用情况分为推荐使用他汀类药物（SR）、考虑使用（SC）和不推荐使用（SN）。在根据CAC评分为0、1 - 100和>100对受试者进行分层后，采用Cox回归分析来估计风险比（HR）及95%置信区间（CI）。计算了每组在研究随访期间预防一例死亡事件所需的治疗人数（NNT）。
平均年龄为54.4±7.5岁，男性占76.3%。在中位随访5年期间（四分位间距；3 - 7年），共有251例（0.8%）全因死亡。在校正心脏危险因素后，CAC>100与各他汀类药物组的死亡率独立相关（例如，SR组：HR，1.60；95%CI，1.07 - 2.38；SC组：HR，2.98；95%CI，1.09 - 8.13；SN组：HR，3.14；95%CI，1.08 - 9.17）。值得注意的是，在SC组和SN组中，与无CAC或CAC为1 - 百的情况相比，CAC>100的患者显示出较低的NNT。
在韩国无症状个体中，根据2013年更新的ACC/AHA指南，CAC评分可能有助于重新确定患者接受他汀类药物治疗的适用情况。
