Subclinical Coronary Atherosclerosis: Implication of Coronary Computed Tomography Angiography Findings among Statin Candidates according to the 2013 ACC/AHA Cholesterol Management Guidelines.

Abstract

ObjectiveTo analyze the cardiovascular outcome of statin medication in individuals retrospectively categorized on the basis of the 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines risk assessment and to determine the additional prognostic value of coronary computed tomography angiography (CCTA) in assessing cardiovascular disease (CVD) risk in this group.Materials and MethodsThis retrospective study reviewed 4255 asymptomatic individuals who had undergone self-referred CCTA with a median follow-up period of 87 months. The primary endpoint was major adverse cardiac events (MACEs); these included cardiac death, nonfatal myocardial infarction, and unstable angina. Individuals recommended for statins according to the ACC/AHA guidelines were analyzed by their assessed risk.ResultsMACE occurrence was significantly higher in the statin-recommended (SR) group with significant coronary artery disease (CAD) than in those with insignificant CAD (p < 0.001). In individuals with a normal coronary artery on CCTA, MACEs did not occur regardless of statin medication. In the SR group with significant CAD, there was no significant difference between statin users and non-users (p = 0.810). However, in cases with insignificant CAD, the event-free survival was significantly lower among statin users (p = 0.034). In patients recommended for moderate-intensity statins, the segment involvement score on CCTA was significantly associated with a higher risk of MACEs (hazard ratio 2.558; p = 0.001).ConclusionCCTA might have a potential role in CVD risk stratification among asymptomatic statin candidates.