Physicians' Academy for Cardiovascular Education

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

Literature - Venkataraman P, Huynh Q, Nicholls SJ et al. - Atherosclerosis. 2021 Oct;334:57-65. doi: 10.1016/j.atherosclerosis.2021.08.002.

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 [1]. This study assessed the benefit of a CAC-guided risk-management protocol in asymptomatic, statin naïve participants with a family history of premature CAD.

Study design

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.

Primary outcome

The primary outcome of this analysis was change in pooled cohort equation (PCE) score-based predicted 10-year risk at 12-months follow-up.

Main results

Conclusion

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.

References

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Find this article online at Atherosclerosis.

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