957Evaluation of coronary artery calcium score for statin treatment strategy according to ESC guidelines in Asymptomatic asian adults

Abstract

Background: The European Society of Cardiology (ESC) guidelines advocate the use of statin treatment for primary prevention of cardiovascular disease. Purpose: We therefore sought to assess the usefulness of coronary artery calcium score (CACS) for stratifying potential candidates of statin therapy among asymptomatic Korean adults. Methods: A total of 65,086 Korean adults who underwent CACS as part of a general health examination were enrolled in the current study. We calculated the 10-year risk for the CVD mortality following ESC guidelines, where we used sex-specific Systematic Coronary Risk Evaluation equation for low-risk countries. Statin trial eligibility was categorized as no treatment (NT), treatment considered (TC), and treatment recommended (TR) groups, according to ESC guidelines. The distribution and incidence of all-cause mortality per 1,000 person-years were examined according to CACS strata across statin eligibility group. Multivariable Cox proportional regression was used to estimate hazard ratios (HR) with 95% confidence intervals (95% CI) for all-cause mortality, after stratifying the subjects according to CAC scores of 0, 1-100, and >100. Results: Mean age was 50.2±10.0 years, and 69.4% were male. During a 4.5-year median follow-up (interquartile range; 3.1-6.3), there were 474 (0.7%) deaths from all-causes. The proportion of zero CACS was more than 30% among overall statin eligibility group, whereas the proportion of CACS >100 tended to increase within the TR group (31%), compared with the TC (19.9%) and NT (2.8%) groups, respectively. Patients with CACS >100 displayed a higher all-cause mortality incidence per 1,000 person-years in comparison to patients with zero CACS or CACS 1-100 across each statin eligibility group. Notably, the presence of CACS >100 was independently associated with higher mortality in TR and TC groups after adjusting for cardiovascular risk factors (e.g., TR: HR, 1.68; 95% CI, 1.08-2.63, and TC: HR, 1.67; 95% CI, 1.05-2.66) (Figure). (Figure Presented) Conclusion: In asymptomatic Korean adults, CACS might help in reclassifying patient's eligibility for statin treatment strategy based on updated 2016 ESC guidelines.