Cardiovascular Risk

What Good Is Identifying the Lowest of the Low?

JoAnne M. Foody, MD

Disclosures

Journal Watch 

In This Article

Abstract and Introduction

Abstract

Coronary artery calcium may be better than hsCRP for stratifying cardiac risk, but the benefits of using either marker to guide statin treatment in low-risk patients remain unproven.

Introduction

In the placebo-controlled JUPITER trial, rosuvastatin significantly lowered the incidence of cardiovascular events in healthy men (aged ≥50) and women (aged ≥60) with normal LDL levels (<130 mg/dL) and elevated high-sensitivity C-reactive protein (hsCRP) levels (≥2 mg/L; JW Cardiol Nov 10 2008). To evaluate whether "JUPITER-eligible" patients could be further risk-stratified to avoid potentially unnecessary treatment, investigators analyzed data from >2000 participants in the MESA study who underwent computed tomography for baseline coronary artery calcium (CAC) scores.

A total of 950 MESA participants met JUPITER-eligibility criteria. During a median follow-up of 5.8 years, the 25% of patients with baseline CAC scores >100 accounted for nearly 75% of all coronary events and about 60% of all cardiovascular events. Almost 50% of JUPITER-eligible patients had CAC scores of 0. This group had an extremely low event rate; applying the hazard ratios from JUPITER, the number needed to treat (NNT) with rosuvastatin to prevent one coronary event was 549. In contrast, NNTs were 94 for CAC scores of 1–100 and 24 for CAC scores >100. Similarly, NNTs for any cardiovascular event were 124, 54, and 19 for CAC scores of 0, 1–100, and >100, respectively. In the entire cohort (including patients who were not JUPITER-eligible), any detectable CAC was associated with significantly increased risks for coronary and cardiovascular events; no such association was found with hsCRP levels.

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