Including coronary artery calcium scores to guide treatment in a specialist lipid clinic setting

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The Multi-Ethnic Study of Atherosclerosis demonstrated that coronary artery calcium (CAC) scoring has proven to be an effective tool at guiding lipid lowering therapy in patients with dyslipidaemia who are at risk of atherosclerotic cardiovascular disease (ASCVD) in the setting of a cohort study. The 2019 joint ESC/EAS dyslipidaemia guidelines identify a number of risk modifiers to stratify ASCVD risk from low to very-high including Lipoprotein (a) [Lp(a)] and the identification of familial hypercholesterolaemia (FH) mutations. Purpose 1) To determine whether CAC scoring can improve the risk assessment of ASCVD in a lipid clinic setting and therefore act as a more effective guide for clinicians when implementing lipid lowering therapy. 2) To compare CAC scores in patients grouped by Lp(a) levels and FH mutations. Methods A retrospective cohort analysis of patients attending a specialist lipid clinic from July to December 2021 in a tertiary referral centre. Data was collected in July/August 2022. Patients were divided into two groups, those with a CAC score of 0 and greater than 0. Data collected included patient risk factors and modifiers as described in the 2019 joint ESC/EAS dyslipidaemia guidelines, serum Lp(a) levels and FH mutation status. Statistical analysis with SPSS software applied the Mann-Whitney and Chi Squared test. Results 49.4% patients (n=41) had a CAC score of greater than 0. Of the patients classified as very-high risk, 91.3% (n=21) had a CAC score of greater than 0. For those classified as high risk, 26.5% (n=9) had a CAC score greater than 0. The mean Lp(a) plasma level was 124nmol/L for a CAC score of 0, compared to 249nmol/L for a CAC score of greater than 0 (U=562,p=0.02). 23 patients had FH mutations, of which 47.8% (n=11) had CAC scores of greater than 0 (χ2 = 2.15, p= 0.340). Conclusion This initial analysis describes CAC scores in patients attending a specialist lipid clinic classified by ASCVD risk and risk modifiers. It suggests CAC scores have a role, either additional or confirmatory, in ASCVD risk assessment. Further analysis is required to include additional risk modifiers, expand the cohort and preform a more granular stratification of the group by CAC score.