Al-Kindi Sadeer, Tashtish Nour, Rashid Imran, Sullivan Claire, Neeland Ian J, Robinson Monique, Gross Ewa M, Shaw Leslee, Cainzos-Achirica Miguel, Nasir Khurram, Kreatsoulas Catherine, Gilkeson Robert, Simon Daniel I, Rajagopalan Sanjay
Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106, United States.
Case Western Reserve University School of Medicine, Cleveland, OH 44106, United States.
Am J Prev Cardiol. 2022 Sep 11;12:100392. doi: 10.1016/j.ajpc.2022.100392. eCollection 2022 Dec.
Prior studies have suggested significant underutilization of statins in women and worse cardiovascular outcomes. Data examining the impact of real-world coronary artery calcium (CAC) scoring to improve utilization of preventive therapies and outcomes is limited.
In a prospective registry study of low cost or no-cost CAC scoring between 2014 and 19 (CLARIFY Study, Clinicaltrials.gov NCT04075162), we sought to study the association of CAC scoring on statin utilization, blood lipids (LDL, total cholesterol, triglycerides), downstream ischemic testing (coronary angiography and stress testing), coronary revascularization and outcomes (MI, stroke, death) in women compared with men. Eligibility for statin initiation was defined as atherosclerotic cardiovascular disease pooled cohort equation (ASCVD-PCE) ≥ 7.5% and CAC≥100/≥75th percentile.
A total of 52,151 patients (26,336 women and 25,815 men) were enrolled. Women were more likely to have CAC 0 (51% vs 30%, <0.001). Among patients not eligible for statin by PCE, CAC reclassified statin eligibility in a smaller proportion of women than men (25.4% vs 30%, <0.001), while among patients eligible for statin by PCE, CAC was more likely to downgrade risk/statin eligibility in women than men (30.1% vs 48.4%, <0.001). After CAC scoring, statin initiation was similar in women and men, but high-intensity statin use was lower in women (CAC-adjusted HR 0.76 [0.70-0.83], <0.001). Women had similar reduction in LDL cholesterol levels compared with men. There was no difference between men and women with respect to CAC-stratified major adverse cardiovascular events.
CAC scoring primarily served to downgrade statin eligibility in women compared with men. Women had similar CAC risk-guided reductions in LDL cholesterol compared with men.
先前的研究表明，他汀类药物在女性中的使用严重不足，且心血管结局更差。关于真实世界中冠状动脉钙化（CAC）评分对改善预防性治疗的使用情况及结局的影响的数据有限。
在一项2014年至2019年间进行的低成本或免费CAC评分的前瞻性注册研究（CLARIFY研究，Clinicaltrials.gov NCT04075162）中，我们试图研究CAC评分与他汀类药物使用、血脂（低密度脂蛋白、总胆固醇、甘油三酯）、下游缺血性检查（冠状动脉造影和负荷试验）、冠状动脉血运重建及结局（心肌梗死、中风、死亡）在女性与男性中的关联。启动他汀类药物治疗的 eligibility标准定义为动脉粥样硬化性心血管疾病合并队列方程（ASCVD - PCE）≥7.5%且CAC≥100/≥第75百分位数。
共纳入52,151例患者（26,336例女性和25,815例男性）。女性更有可能CAC为0（51%对30%，<0.001）。在根据PCE不符合他汀类药物治疗eligibility标准的患者中，CAC重新分类他汀类药物eligibility的女性比例低于男性（25.4%对30%，<0.001），而在根据PCE符合他汀类药物治疗eligibility标准的患者中，CAC更有可能降低女性的风险/他汀类药物eligibility，而不是男性（30.1%对48.4%，<0.001）。在进行CAC评分后，女性和男性启动他汀类药物治疗的情况相似，但女性高强度他汀类药物的使用较低（CAC校正风险比0.76 [0.70 - 0.83]，<0.001）。与男性相比，女性低密度脂蛋白胆固醇水平的降低幅度相似。在按CAC分层的主要不良心血管事件方面，男性和女性之间没有差异。
与男性相比，CAC评分主要导致女性他汀类药物eligibility降低。与男性相比，女性在CAC风险指导下低密度脂蛋白胆固醇的降低幅度相似。
