Published online before print April 1, 2004, doi: 10.1161/01.ATV.0000127024.40516.ef
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© 2004 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Progression of Coronary Artery Calcium and Risk of First Myocardial Infarction in Patients Receiving Cholesterol-Lowering Therapy
From Tulane University School of Medicine (P.R.), New Orleans, La; EBT Research Foundation (T.Q.C.), Nashville, Tenn; and Atlanta Cardiovascular Research Institute (L.J.S.), Atlanta, Ga.
Correspondence to Dr Paolo Raggi, 1430 Tulane Avenue, SL-48. New Orleans, LA 70112. E-mail praggi{at}tulane.edu
Objective— Statins reduce cardiovascular risk and slow progression of coronary artery calcium (CAC). We investigated whether CAC progression and low-density lipoprotein (LDL) reduction have a complementary prognostic impact.
Methods and Results— We measured the change in CAC in 495 asymptomatic subjects submitted to sequential electron-beam tomography (EBT) scanning. Statins were started after the initial EBT scan. Myocardial infarction (MI) was recorded in 41 subjects during a follow-up of 3.2±0.7 years. Mean LDL level did not differ between groups (118±25 mg/dL versus 122±30 mg/dL, MI versus no MI). On average, MI subjects demonstrated a CAC change of 42%±23% yearly; event-free subjects showed a 17%±25% yearly change (P=0.0001). Relative risk of having an MI in the presence of CAC progression was 17.2-fold (95% CI: 4.1 to 71.2) higher than without CAC progression (P<0.0001). In a Cox proportional hazard model, the follow-up score (P=0.034) as well as a score change >15% per year (P<0.001) were independent predictors of time to MI.
Conclusions— Progression of CAC was significantly greater in patients receiving statins who had an MI compared with event-free subjects despite similar LDL control. Continued expansion of CAC may indicate failure of some patients to benefit from statin therapy and an increased risk of having cardiovascular events.
Statins reduce risk by only 30%, and a direct measurement of change in atherosclerosis burden may provide a clue to the persistent risk measured in subjects at risk. On sequential computed tomography scans, the progression of coronary calcification was significantly greater in patients who had an event compared with event-free subjects despite similar low-density lipoprotein control.
Key Words: atherosclerotic imaging • computed tomograph • prognosis • low-density lipoprotein cholesterol
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