Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy.
Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Torino, Italy.
Rev Esp Cardiol (Engl Ed). 2022 Jun;75(6):506-514. doi: 10.1016/j.rec.2021.08.002. Epub 2021 Sep 3.
Coronary artery calcium (CAC) score improves the accuracy of risk stratification for atherosclerotic cardiovascular disease (ASCVD) events compared with traditional cardiovascular risk factors. We evaluated the interaction of coronary atherosclerotic burden as determined by the CAC score with the prognostic benefit of lipid-lowering therapies in the primary prevention setting.
We reviewed the MEDLINE, EMBASE, and Cochrane databases for studies including individuals without a previous ASCVD event who underwent CAC score assessment and for whom lipid-lowering therapy status stratified by CAC values was available. The primary outcome was ASCVD. The pooled effect of lipid-lowering therapy on outcomes stratified by CAC groups (0, 1-100,> 100) was evaluated using a random effects model.
Five studies (1 randomized, 2 prospective cohort, 2 retrospective) were included encompassing 35 640 individuals (female 38.1%) with a median age of 62.2 [range, 49.6-68.9] years, low-density lipoprotein cholesterol level of 128 (114-146) mg/dL, and follow-up of 4.3 (2.3-11.1) years. ASCVD occurrence increased steadily across growing CAC strata, both in patients with and without lipid-lowering therapy. Comparing patients with (34.9%) and without (65.1%) treatment exposure, lipid-lowering therapy was associated with reduced occurrence of ASCVD in patients with CAC> 100 (OR, 0.70; 95%CI, 0.53-0.92), but not in patients with CAC 1-100 or CAC 0. Results were consistent when only adjusted data were pooled.
Among individuals without a previous ASCVD, a CAC score> 100 identifies individuals most likely to benefit from lipid-lowering therapy, while undetectable CAC suggests no treatment benefit.
与传统心血管危险因素相比，冠状动脉钙（CAC）评分可提高动脉粥样硬化性心血管疾病（ASCVD）事件风险分层的准确性。我们评估了 CAC 评分所确定的冠状动脉粥样硬化负担与降脂治疗在一级预防中的预后获益之间的相互作用。
我们检索了 MEDLINE、EMBASE 和 Cochrane 数据库，纳入了未发生过 ASCVD 事件的个体的研究，这些个体接受了 CAC 评分评估，并且可以根据 CAC 值分层的降脂治疗状态。主要结局是 ASCVD。使用随机效应模型评估 CAC 分组（0、1-100、>100）中降脂治疗对结局的影响。
共纳入 5 项研究（1 项随机、2 项前瞻性队列、2 项回顾性），包括 35640 名个体（女性 38.1%），中位年龄为 62.2 岁[范围：49.6-68.9]，低密度脂蛋白胆固醇水平为 128（114-146）mg/dL，随访时间为 4.3（2.3-11.1）年。随着 CAC 水平的增加，ASCVD 的发生率在接受和未接受降脂治疗的患者中均呈稳步上升趋势。比较有（34.9%）和无（65.1%）治疗暴露的患者，在 CAC>100 的患者中，降脂治疗与 ASCVD 的发生率降低相关（OR，0.70；95%CI，0.53-0.92），但在 CAC 为 1-100 或 CAC 为 0 的患者中则不然。仅汇总调整后数据的结果也是一致的。
在无 ASCVD 病史的个体中，CAC>100 可识别最有可能从降脂治疗中获益的个体，而 CAC 无法检测则提示无治疗获益。
