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Coronary artery calcium scanning improves risk stratification
In the JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin) study, patients with low cholesterol levels but raised high-sensitivity C reactive protein levels were seen to benefit from treatment with rosuvastatin, although overall cardiovascular events were low. In this study, the authors investigated whether the use of coronary artery calcium (CAC) scoring could further stratify risk in a population of patients from the MESA (Multi-Ethnic Study of Atherosclerosis) who all met the criteria for entry into the JUPITER study.
Nine hundred and fifty participants were selected, and the burden of CAC was scored as either 0, 1–100 or >100. Coronary heart disease and cardiovascular disease event rates and multivariable-adjusted hazard ratios were compared after stratifying among the three CAC groups. The 5-year number needed to treat was calculated by applying the benefit recorded in JUPITER to the event rates within each CAC stratum.
The median follow-up was 5.8 years. Four hundred and forty-four (47%) individuals in the MESA JUPITER population had CAC scores of 0, and in this group, very low rates of coronary heart disease events were seen: 0.8 per 1000 person-years. Seventy-four per cent of all coronary events occurred in 239 (25%) participants with CAC scores of more than 100: 20.2 per 100 person-years. For cardiovascular disease, therefore, the number needed to treat was 124 for patients with a …