Abstract:
BACKGROUND:The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines recommend primary prevention with statins for individuals with ≥7.5% 10-year risk for atherosclerotic cardiovascular disease (ASCVD). Everyone living long enough will become eligible for risk-based statin therapy due to age alone. OBJECTIVES:This study sought to personalize ACC/AHA risk-based statin eligibility using noninvasive assessment of subclinical atherosclerosis. METHODS:In 5,805 BioImage participants without known ASCVD at baseline, those with ≥7.5% 10-year ASCVD risk were down-classified from statin eligible to ineligible if imaging revealed no coronary artery calcium (CAC) or carotid plaque burden (cPB). Intermediate-risk individuals were up-classified from optional to clear statin eligibility if CAC was ≥100 (or equivalent cPB). RESULTS:At a median follow-up of 2.7 years, 91 patients had coronary heart disease and 138 had experienced a cardiovascular disease event. Mean age of the participants was 69 years, and 86% qualified for ACC/AHA risk-based statin therapy, with high sensitivity (96%) but low specificity (15%). CAC or cPB scores of 0 were common (32% and 23%, respectively) and were associated with low event rates. With CAC-guided reclassification, specificity for coronary heart disease events improved 22% (p < 0.0001) without any significant loss in sensitivity, yielding a binary net reclassification index (NRI) of 0.20 (p < 0.0001). With cPB-guided reclassification, specificity improved 16% (p < 0.0001) with a minor loss in sensitivity (7%), yielding an NRI of 0.09 (p = 0.001). For cardiovascular disease events, the NRI was 0.14 (CAC-guided) and 0.06 (cPB-guided). The positive NRIs were driven primarily by down-classifying the large subpopulation with CAC = 0 or cPB = 0. CONCLUSIONS:Withholding statins in individuals without CAC or carotid plaque could spare a significant proportion of elderly people from taking a pill that would benefit only a few. This individualized disease-guided approach is simple and easy to implement in routine clinical practice.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Mortensen MB,Fuster V,Muntendam P,Mehran R,Baber U,Sartori S,Falk Edoi
10.1016/j.jacc.2016.05.084subject
Has Abstractpub_date
2016-08-30 00:00:00pages
881-91issue
9eissn
0735-1097issn
1558-3597pii
S0735-1097(16)33608-7journal_volume
68pub_type
临床试验,杂志文章,多中心研究abstract::Sudden death in healthy athletes is uncommon but, when it occurs, the primary mechanism is cardiovascular. The major cause of sudden death in the young athlete is hypertrophic cardiomyopathy or related conditions characterized by left ventricular hypertrophy, aortic rupture due to cystic medial necrosis and congenital...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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abstract:BACKGROUND:This study demonstrated the safety and effectiveness of baroreflex activation therapy (BAT) in patients with heart failure with reduced ejection fraction (HFrEF). OBJECTIVES:The BeAT-HF (Baroreflex Activation Therapy for Heart Failure) trial was a multicenter, prospective, randomized, controlled trial; subj...
journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(03)00158-x
更新日期:2003-04-16 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2005-01-18 00:00:00
abstract:BACKGROUND:Patients with diabetes appear to be at elevated risk of atherothrombotic events. OBJECTIVES:The purpose of this study was to determine the effect of antiplatelet therapy with ticagrelor on recurrent ischemic events in patients with diabetes and prior myocardial infarction (MI). METHODS:We examined the subg...
journal_title:Journal of the American College of Cardiology
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更新日期:2016-06-14 00:00:00
abstract::The relation between perfusion of the infarct-related artery and changes in left ventricular volume and function during the month after a first myocardial infarction was examined in 40 patients who did not receive thrombolytic therapy. Infarct artery perfusion was documented at predischarge coronary angiography, and l...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80298-x
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
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更新日期:1995-10-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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更新日期:2015-09-15 00:00:00
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更新日期:2014-01-28 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:1990-07-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1991-03-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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更新日期:1987-03-01 00:00:00
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更新日期:2018-03-06 00:00:00
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更新日期:2010-05-18 00:00:00