scholarly journals Vascular age derived from coronary artery calcium score on the risk stratification of individuals with heterozygous familial hypercholesterolaemia

2019 ◽  
Vol 21 (3) ◽  
pp. 251-257 ◽  
Author(s):  
Marcio H Miname ◽  
Marcio Sommers Bittencourt ◽  
Alexandre C Pereira ◽  
Cinthia E Jannes ◽  
Jose E Krieger ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Primary Prevention ◽  
Coronary Artery Calcium ◽  
Familial Hypercholesterolaemia ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Vascular Age ◽  
Ascvd Risk ◽  
Heterozygous Familial Hypercholesterolaemia

Abstract Aims The objective of this study was to evaluate if vascular age derived from coronary artery calcium (CAC) score improves atherosclerosis cardiovascular disease (ASCVD) risk discrimination in primary prevention asymptomatic heterozygous familial hypercholesterolaemia (FH) patients undergoing standard lipid-lowering therapy. Methods and results Two hundred and six molecularly confirmed FH individuals (age 45 ± 14 years, 36% males, baseline LDL-cholesterol 6.2 ± 2.2 mmol/L; 239 ± 85mg/dL) were followed by 4.4 ± 2.9 years (median: 3.7 years, interquartile ranges 2.7–6.8). CAC measurement was performed, and lipid-lowering therapy was optimized according to FH guidelines. Vascular age was derived from CAC and calculated according to the Multi Ethnic Study of Atherosclerosis algorithm. Risk estimation based on the Framingham equations was calculated for both biological (bFRS) and vascular (vaFRS) age. During follow-up, 15 ASCVD events (7.2%) were documented. The annualized rate of events for bFRS <10%, 10–20%, and >20% was respectively: 8.45 [95% confidence interval (CI) 3.17–22.52], 23.28 (95% CI 9.69–55.94), and 28.13 (95% CI 12.63–62.61) per 1000 patients. The annualized rate of events for vaFRS <10%, 10–20%, and >20% was respectively: 0, 0, and 50.37 (95% CI 30.37–83.56) per 1000 patients. vaFRS presented a better discrimination for ASCVD events compared to bFRS 0.7058 (95% CI 0.5866–0.8250) vs. vaFRS 0.8820 (95% CI 0.8286–0.9355), P = 0.0005. Conclusion CAC derived vascular age can improve ASCVD risk discrimination in primary prevention FH subjects. This tool may help further stratify risk in FH patients already receiving lipid-lowering medication who might be candidates for further treatment with newer therapies.

Abstract 12119: Class I Indication for Statin Therapy in Primary Prevention by Three Cholesterol Guidelines and Prevalence of Coronary Artery Calcium in Asymptomatic Adults: Multi-ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Peter Flueckiger ◽  
Waqas Qureshi ◽  
Michael Blaha ◽  
Gregory Burke ◽  
Veit Sandfort ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Primary Prevention ◽  
Statin Therapy ◽  
Coronary Artery Calcium ◽  
Predictive Value ◽  
Class I ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Cholesterol Guidelines

Introduction:Statin therapy for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) events provides greater relative risk reduction compared with primary prevention. Coronary artery calcium (CAC) identifies individuals with established but subclinical ASCVD disease. Identifying a population with a higher prevalence of CAC may improve the benefit and efficacy of statin therapy in the primary prevention of ASCVD. We assessed the accuracy of class I statin eligibility criterion for primary prevention by the 2013 ACC/AHA cholesterol guidelines for the presence of CAC and compared it with class I criterion for lipid lowering therapy eligibility by the 2004 NCEP/ATP III and 2011 ESC/EAS cholesterol guidelines. Methods:4723 out of the 6814 total participants not taken statins during the baseline exam and with complete data including CAC were included in analysis. We evaluated the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) of class I recommendation for lipid lowering therapy (high risk designation) by the three cholesterol guidelines for three categories of prevalent CAC [CAC present/absent; CAC ≥ 100; CAC ≥300 Agatston] in participants of the Multi Ethnic Study of Atherosclerosis (MESA) Results:Mean age 59±9 years, 47% male, 37% white, 28% black, 23% Hispanic, 12% Asian, 7.5% with diabetes, 35% current/former smokers, mean glomerular filtration rate of 83±18 ml/min and mean BMI of 28±6 kg/m2. 1978(41.9%), 816(17.3%) and 392(8.3%) had CAC present, CAC ≥100 and CAC ≥300 respectively. Table 1 shows the results. Conclusions:The SN, SP, PPV and NPV of class I statin eligibility criteria by the 3 guidelines for subclinical ASCVD depends significantly on the definition of CAC. The 2013 ACC/AHA class I statin eligibility has a higher SN, lower SP, and higher NPV when compared with the 2004 NCEP/ATP III and 2011 ESC/EAS class I criterion for statin therapy across all three CAC categories.

Coronary Artery Calcium and Cardiovascular Events in Patients With Familial Hypercholesterolemia Receiving Standard Lipid-Lowering Therapy

2019 ◽  
Vol 12 (9) ◽  
pp. 1797-1804 ◽  
Author(s):  
Marcio H. Miname ◽  
Marcio Sommer Bittencourt ◽  
Sérgio R. Moraes ◽  
Rômulo I.M. Alves ◽  
Pamela R.S. Silva ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Familial Hypercholesterolemia ◽  
Coronary Artery Calcium ◽  
Cardiovascular Events ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy

scholarly journals Implications of coronary artery calcium testing on risk stratification for lipid-lowering therapy according to the 2016 European Society of Cardiology recommendations: The MESA study

2018 ◽  
Vol 25 (17) ◽  
pp. 1887-1898 ◽  
Author(s):  
Marcio S Bittencourt ◽  
Ron Blankstein ◽  
Michael J Blaha ◽  
Veit Sandfort ◽  
Arthur S Agatston ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Mortality ◽  
European Society ◽  
Coronary Artery Calcium ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
European Society Of Cardiology

Aims The European Society of Cardiology (ESC) guideline on cardiovascular risk assessment considers coronary artery calcium a class B indication for risk assessment. We evaluated the degree to which coronary artery calcium can change the recommendation for individuals based on a change in estimated risk. Methods and results We stratified 5602 MESA participants according to the ESC recommendation as: no lipid-lowering treatment recommended ( N = 2228), consider lipid-lowering treatment if uncontrolled ( N = 1686), or lipid-lowering treatment recommended ( N = 1688). We evaluated the ability of coronary artery calcium to reclassify cardiovascular risk. Among the selected sample, 54% had coronary artery calcium of zero, 25% had coronary artery calcium of 1–100 and 21% had coronary artery calcium greater than 100. In the lipid-lowering treatment recommended group 31% had coronary artery calcium of zero, while in the lipid-lowering treatment if uncontrolled group about 50% had coronary artery calcium of zero. The cardiovascular mortality rate was 1.7%/10 years in the lipid-lowering treatment if uncontrolled, and 7.0%/10 years in the lipid-lowering treatment recommended group. The absence of coronary artery calcium was associated with 1.4%/10 years in the lipid-lowering treatment if uncontrolled group and 3.0%/10 years in the lipid-lowering treatment recommended group. Compared with coronary artery calcium of zero, any coronary artery calcium was associated with significantly higher cardiovascular mortality in the lipid-lowering treatment recommended group (9.0%/10 years), whereas only coronary artery calcium greater than 100 was significantly associated with a higher cardiovascular mortality in the lipid-lowering treatment if uncontrolled group (3.2%/10 years). Conclusion The absence of coronary artery calcium is associated with a low incidence of cardiovascular mortality or coronary heart disease events even in individuals in whom lipid-lowering therapy is recommended. A significant proportion of individuals deemed to be candidates for lipid-lowering therapy might be reclassified to a lower risk group with the use of coronary artery calcium.

Standard and intensive lipid-lowering therapy with statins for the primary prevention of vascular diseases: a population-based study

2013 ◽  
Vol 70 (1) ◽  
pp. 99-108 ◽  
Author(s):  
D. Macías Saint-Gerons ◽  
C. de la Fuente Honrubia ◽  
D. Montero Corominas ◽  
M. J. Gil ◽  
F. de Andrés-Trelles ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Vascular Diseases ◽  
Population Based ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Population Based Study ◽  
Lowering Therapy

FEATURES OF THE LIPID SPECTRUM IN PATIENTS WITH ACUTE CORONARY SYNDROME IN THE LONG-TERM PERIOD AFTER CORONARY ARTERY BYPASS GRAFTING

2021 ◽  
pp. 8-12
Author(s):  
М.А. НУРЖАНОВА ◽  
А.Е. ТЕМУРОВА ◽  
Ж.Ш. БАБАК ◽  
Г.Б. БЕКТІБАЙ ◽  
Ш.Б. БАТЫР ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Bypass Grafting ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Lipid Spectrum

В данной статье представлены особенности липидного спектра у пациентов с острым коронарным синдромом в отдаленном периоде после операции коронарного шунтирования (КШ), в сравнении групп с Инфарктом миокарда (ИМ) и Нестабильной стенокардии (НС), а также результаты приверженности к гиполипидемической терапии с особенностями достижения целевых уровней липидного спектра. Полученные результаты представляют, что по липидному спектру группы идентичны между собой и отличаются от нормы, пациенты с низкой приверженности к гиполипидемической терапии и не достигают целевых уровень по холестерин липопротеинов низкой плотности (ХС-ЛПНП) рекомендованным Европейского кардиологического общества (ESC, ЕОК) от 2019г. This article presents the features of the lipid spectrum in patients with acute coronary syndrome in the long-term period after coronary artery bypass grafting (CABG) surgery, in comparison with the groups with myocardial infarction and Unstable angina pectoris, as well as the results of adherence to lipid-lowering therapy with particularities of achieving target levels of the lipid spectrum. The results obtained represent that in terms of the lipid spectrum the groups are identical and differ from the norm, patients with low adherence to lipid-lowering therapy and do not reach the target levels for low-density lipoprotein cholesterol (LDL-C) recommended by the European Society of Cardiology (ESC) from 2019.

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