CAC Score Improves Coronary and CV Risk Assessment Above Statin Indication by ESC and AHA/ACC Primary Prevention Guidelines

Mahabadi, Amir A.; Möhlenkamp, Stefan; Lehmann, Nils; Kälsch, Hagen; Dykun, Iryna; Pundt, Noreen; Moebus, Susanne; Jöckel, Karl‐Heinz; Erbel, Raimund; Investigators, Heinz Nixdorf Recall Study

doi:10.1016/j.jcmg.2016.03.022

Cited by 139 publications

(87 citation statements)

References 28 publications

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“…Coronary atherosclerosis is a major cause of coronary heart disease (CHD). The common risk factors contributing to the development of CHD are advanced age, smoking, obesity, hypertension, high cholesterol and diabetes, etc . In the case of coronary atherosclerosis, lipids drive inflammation on the endothelium and accelerate plaque formation on vulnerable coronaries .…”

Section: Introductionmentioning

confidence: 99%

Clopidogrel‐associated genetic variants on inhibition of platelet activity and clinical outcome for acute coronary syndrome patients

Wang

et al. 2018

Basic Clin Pharma Tox

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Acute coronary syndrome (ACS) has become a vital disease with high mortality worldwide. A combined antiplatelet therapy (aspirin and a P2Y antagonist) is commonly used to prevent re-infarction in ACS patients who have undergone percutaneous coronary intervention (PCI). Clopidogrel, a P2Y antagonist, plays an important role in the inhibition of platelet aggregation (IPA). However, it is a pro-drug requiring biotransformation by cytochrome P450 (CYP450). The aim of this study is to unravel the effect of clopidogrel-associated genetic variants on inhibition of platelet activity and clinical outcomes in ACS patients. In our study, a total of 196 patients with metabolic gene polymorphism of clopidogrel were enrolled, and their antiplatelet effect as well as their cardiovascular events were collected. Approximately 2 mL of venous blood samples were used for genotype detection and another 4 mL were collected for platelet reactivity with thrombelastography. The primary clinical end-point was defined as a combination of cardiovascular mortality and revascularization for targeted vascular lesion. Based on the results of IPA, the prevalence of high on-treatment platelet reactivity (HPR) was 17.3% and the majority of patients (82.7%) obtained normal on-treatment platelet reactivity (NPR). The HPR group had significantly higher body mass index (BMI) and lower arachidonic acid (AA) induced IPA (P < 0.05). Therapy including Glycoprotein (GP) IIb/IIIa antagonist increased IPA (P < 0.05). ADP-induced IPA effect was lower with the presence of CYP2C19*2, *3 and paraoxonase (PON)1 Q192R loss-of-function (LOF) alleles, respectively (P < 0.05). Multivariate logistic regression analysis demonstrated that aspirin resistance (AA-induced IPA < 50%) had a greater risk of the occurrence of major adverse cardiovascular events (MACE) (OR = 3.817; 95% CI: 1.672-8.700; P = 0.002). CYP2C19*2 LOF alleles were associated with high risk of MACE in 1-year post PCI operations (OR = 2.571; 95% CI: 1.143-5.780; P = 0.030). For the ACS patients, the presence of CYP2C19*2 and PON1 Q192R LOF alleles were the major drivers of HPR.

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Section: Introductionmentioning

confidence: 99%

Clopidogrel‐associated genetic variants on inhibition of platelet activity and clinical outcome for acute coronary syndrome patients

Wang

et al. 2018

Basic Clin Pharma Tox

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“…A similar analysis was recently preformed by Mahabadi et al [14], who applied both AHA/ACC guidelines and the ESC guidelines to participants of the Heinz Nixdorf Recall study. Similar to MESA, this study is a prospective cohort of individuals who did not have any known CVD at baseline.…”

Section: Use Of Cac In Light Of Recent Guidelines?mentioning

confidence: 91%

“…This study found that for both guidelines, and irrespective of statin indication, individuals with higher CAC scores had a higher CHD and CVD event rate (Fig. 6) [14]. Notably, CAC was absent in 43% of individuals who were met statin indications by the ESC guidelines and 53% of the individuals who met statin indication by the AHA/ACC guidelines.…”

Section: Use Of Cac In Light Of Recent Guidelines?mentioning

confidence: 98%

The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

et al. 2017

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Over the last two decades coronary artery calcium (CAC) scanning has emerged as a quick, safe, and inexpensive method to detect the presence of coronary atherosclerosis. Data from multiple studies has shown that compared to individuals who do not have any coronary calcifications, those with severe calcifications (i.e., CAC score >300) have a 10-fold increase in their risk of coronary heart disease events and cardiovascular disease. Conversely, those that have a CAC of 0 have a very low event rate (~0.1%/year), with data that now extends to 15 years in some studies. Thus, the most notable implication of identifying CAC in individuals who do not have known cardiovascular disease is that it allows targeting of more aggressive therapies to those who have the highest risk of having future events. Such identification of risk is especially important for individuals who are not on any therapies for coronary heart disease, or when intensification of treatment is being considered but has an uncertain role. This review will highlight some of the recent data on CAC testing, while focusing on the implications of those findings on patient management. The evolving role of CAC in patients with diabetes will also be highlighted.

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“…A CACS of zero (no detectable coronary calcium) has been said to provide a “warranty” against CV events for 10–15 years . For patients in whom statin therapy is recommended by traditional risk factor evaluation, a CACS of zero has been shown to have a very low event risk, on the order of 2–5 events per thousand patient years …”

Section: Coronary Artery Calcium Score and Ascvd Riskmentioning

confidence: 99%

Coronary risk assessment using traditional risk factors with CT coronary artery calcium scoring in clinical practice

Kerut

Hall

Turner³

et al. 2018

Echocardiography

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As coronary artery calcium (CAC) is atherosclerosis and not just a marker of cardiovascular (CV) disease, measurement of a patient's coronary artery calcium score (CACS) is a strong predictor of risk. Clinically performed in asymptomatic patients, the CACS, along with several CV risk factors, namely age, sex, ethnicity, diabetes, tobacco use, family history, cholesterol level, blood pressure, and use of cholesterol or hypertensive medications, provide a predictive model of 10 year risk for CV events. A smartphone "App" makes this quick to obtain and use. This helps the clinician in making recommendations for both lifestyle changes and statin therapy. Those patients in which the most benefit occur from measurement of a CACS are those at an intermediate CV risk. Measurement of the CACS has become an integral part of the clinician's assessment of a patient's CV risk and for guiding preventative therapies.

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CAC Score Improves Coronary and CV Risk Assessment Above Statin Indication by ESC and AHA/ACC Primary Prevention Guidelines

Cited by 139 publications

References 28 publications

Clopidogrel‐associated genetic variants on inhibition of platelet activity and clinical outcome for acute coronary syndrome patients

Clopidogrel‐associated genetic variants on inhibition of platelet activity and clinical outcome for acute coronary syndrome patients

The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

Coronary risk assessment using traditional risk factors with CT coronary artery calcium scoring in clinical practice

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