Coronary artery calcium-guided statin treatment protocol reduces predicted CV risk
Impact of a coronary artery calcium-guided statin treatment protocol on cardiovascular risk at 12 months: Results from a pragmatic, randomized controlled trial
Introduction and methods
Aim of the study
Coronary artery calcium (CAC) score is a CVD risk tool which may be used to target therapy and encourage patients and physicians to improve risk factor control . This study assessed the benefit of a CAC-guided risk-management protocol in asymptomatic, statin naïve participants with a family history of premature CAD.
The CAUGHT-CAD trial is an investigator-initiated, open-label, multi-center, randomized trial conducted in Australia. A total of 1088 participants were scanned and a CAC score was calculated. Participants with intermediate range CAC scores (between 100-400, n=450) were randomized to disclosing the CAC results to the participant and physician (CAC-disclosed group, n=222) or blinding the CAC score (CAC-blinded group, n=228). In addition to being informed about their CAC-score, participants in the CAC-disclosed group were commenced on atorvastatin 40 mg daily and received a picture of their CT CAC. Participants in both groups received guideline-directed advice regarding diet, exercise and smoking cessation. In both groups, 214 participants completed follow-up.
The primary outcome of this analysis was change in pooled cohort equation (PCE) score-based predicted 10-year risk at 12-months follow-up.
- At 12 months, the absolute PCE risk decreased in the CAC-disclosed group by 1.0% (95% CI 0.13-1.81). In the CAC-blinded group, the absolute PCE risk increased by 0.43% (95%CI 0.11-0.75). This translated to a 1.47% between-group absolute difference and a 18% relative risk reduction.
- In the CAC-disclosed group, total cholesterol was reduced by 1.52 mmol/L (P<0.01) and LDL-c was reduced by 1.39 mmol/L (P< 0.01) compared to baseline. There was no significant change in total cholesterol and LDL-c levels in the CAC-blinded group. 84% of participants in the CAC-disclosed group had an LDL-c <2.5 mmol/L and 43% had an LDL-c level <1.8 mmol/L. In comparison, 13% (P<0.01) and 3% (P< 0.01) of participants in the CAC-blinded group achieved LDL-c <2.5 mmol/L and <1.8 mmol/L, respectively.
- Participants in the CAC-disclosed group had a 2.2 mmHg (-4.47 to 0.04, P=0.05) reduction in average SBP at 12 months, compared to the CAC-blinded group.
- There were no significant differences in DBP, weight, smoking, diabetes, adherence to a low salt diet, regular physical activity, alcohol use and adherence to a heart healthy diet between the two groups at 12 months.
This study showed that CAC-guided statin treatment protocol in asymptomatic, statin naïve participants with a family history of premature CAD led to a 18% relative risk reduction in the pooled cohort equation (PCE) score-based predicted 10-year risk, compared to usual care.
Results of CAUGHT-CAD trial about the impact of the CAC-guided statin treatment protocol on plaque volume change over 3 years are expected later this year.