Proactive CAD strategies fueled by calcium scores lead to benefits for intermediate-risk patients
Using coronary artery calcium (CAC) scores to guide treatment is associated with significant benefits for intermediate-risk patients with a family history of premature coronary artery disease (CAD), according to new data published in JAMA.[1]
Up to 50% of all patients face an intermediate risk of developing CAD, researchers explained, and the optimal treatment strategy for that population remains unclear. The issues is made even more challenging by the fact that medications and lifestyle interventions are not always effective in intermediate-risk patients.
Should care teams be using imaging-derived CAC scores to guide the treatment of this group? Or should that that approach be reserved for high-risk individuals?
To learn more, the study’s authors explored data from more than 400 statin-naive patients with a family history of premature CAD and a CAC score higher than 0, but lower than 400. All patients underwent coronary CT angiography (CCTA) and were randomized to either receive CAC score-informed treatment or usual care.
CAC score-informed treatment included a conversation with a nurse where the patient’s CT images were reviewed and they received educational information about the potential benefits of different lifestyle changes. They also began moderate-intensity statin therapy.
The usual care group, meanwhile, received “standard education” about CAD prevention from their general practitioner, who was blinded to their CAC score. None of them began moderate-intensity statin therapy.
All patients underwent a follow-up health evaluation and CCTA exam after three years. The patients treated based on their CAC score presented with consistent reductions in total cholesterol and LDL-C levels compared to the usual care group.
In addition, the authors found that atherosclerosis had progressed in all patients after three years; however, the change in total plaque volume was significantly lower in the CAC score-informed group than it was in the usual care group. The CAC score-informed group also presented with significantly smaller changes in noncalcified plaque and summed fibrofatty and necrotic core plaque volumes. There was no difference, however, in calcified plaque volumes.
After making certain adjustments, the research group determined that a CAC score-informed treatment strategy was independently associated with changes in total plaque volume. The change was only present in noncalcified plaque volume for patients with a CAC score that was less than 100 at the start of the study. For all other patients, the changes were seen in total, noncalcified and summed fibrofatty and necrotic core plaque volume.
Reviewing these data, the authors believe their findings support the use of CAC scores to guide CAD prevention strategies in intermediate-risk patients.
“Family history of CAD is a common presenting concern for patients and is considered as a risk enhancer rather than being incorporated into most risk calculators,” wrote first author Nitesh Nerlekar, MBBS, MPH, PhD, a cardiologist and cardiac imaging specialist with the Baker Heart and Diabetes Research Institute and Victorian Heart Hospital in Australia, and colleagues. “The CAC score has been used as a potential risk arbiter and has demonstrated excellent prognostic validation. However, it has not seen widespread uptake for various reasons, including inconsistent incremental potential over traditional risk-factor prediction. However, the power of the CAC score also lies in the ability to visually convey the presence of atherosclerosis, unique to that individual, and this has been shown to have significant effects in improving patient adherence to risk reduction therapies.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.