Presence of Calcium Leads to Improved Use of Statins, Aspirin in Asymptomatic Men

November 13, 2006 (Chicago, IL) - Finding coronary artery calcium (CAC) on an EBCT scan appears to improve use of preventive medicine in asymptomatic men above and beyond presence of traditional risk factors, new results from the Prospective Army Coronary Calcium Project suggest. Whether better use of preventive drugs leads to improved outcomes remains unknown, but according to Dr Allen J Taylor (Walter Reed Army Medical Center, Washington, DC), appreciating the impact of scans on patient management is an important piece of the puzzle.

"We've learned that calcium scans are an independent predictor of risk, but the knock against calcium scanning has been that it hasn't previously been shown that the scan leads to improved management decisions or outcomes," Taylor told heart wire during a poster session at the AHA 2006 Scientific Sessions. "This is the first time we've seen that management is shifted by a calcium scan."

Taylor and colleagues looked at use of aspirin, statins, and both medications among 1640 men between the ages of 40 and 50 participating in the PACC project, a community-based screening initiative among asymptomatic, otherwise healthy men. All study participants underwent risk factor assessment and an EBCT scan at study outset.

Baseline use of statins and of aspirin was greater in patients found to have coronary calcium than in patients with no calcium (approximately 10% vs 5% for statins and 18% vs 10% for aspirin)--reflecting more complex risk factor profiles. Over six years of follow-up, both statin and aspirin use increased to a greater degree in patients found to have coronary calcium on baseline EBCT, with the curves for both drugs diverging clearly after the baseline scan.

Taylor et al also assessed whether increased use of preventive drugs associated with presence of CAC was independent of what would be appropriate on the basis of National Cholesterol Education Program (NCEP) criteria, using standard risk factors. They found that, after excluding baseline users of the drugs and controlling for NCEP risk variables, CAC was independently associated with a significantly higher likelihood of statin use, aspirin use, or use of both medications. The odds ratio for drug use based on NCEP risk factors alone was dramatically lower. Odds ratios were unchanged after controlling for depression, somatization, fitness, diet, income, or education.

"There's something that's being recognized as risk, over and above standard risk factors, and that's leading to more use of preventive medication," Taylor told heart wire . What the study can't answer is what's driving the increase in medication use, whether it's patient-driven or physician decision-making, he added. Still, he says, "the bottom line is that this is the first community-based screening study to show that management of patients after calcium screening is improved . . . so it's an important advance in our understanding of this test as a tool in preventive cardiology."

As for whether management decisions lead to improved outcomes, "that's only really addressable by a randomized trial, but I don't think that trial is ever going to be done," Taylor said. "You can reasonably infer that if patients are using statins and aspirin, their outcomes should be better, but that's a leap of faith. This is an important step in the right direction."

Heartwire from Medscape © 2006 Medscape

Cite this: Shelley Wood . Presence of Calcium Leads to Improved Use of Statins, Aspirin in Asymptomatic Men - Medscape - Nov 13, 2006.