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

  • 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.


1. P. Venkataraman, T. Stanton, D. Liew, Q. Huynh, S. Nicholls, G.K. Mitchell, G. F. Watts, A.M. Tonkin, T.H. Marwick, Coronary artery calcium scoring in cardiovascular risk assessment of people with family histories of early onset coronary artery disease, Med. J. Aust. 213 (2020) 170–177.

Find this article online at Atherosclerosis.

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