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Value of Coronary Artery Calcium Scanning in Association With the Net Benefit of Aspirin in Primary Prevention of Atherosclerotic Cardiovascular Disease.
- Source :
-
JAMA cardiology [JAMA Cardiol] 2021 Feb 01; Vol. 6 (2), pp. 179-187. - Publication Year :
- 2021
-
Abstract
- Importance: Higher coronary artery calcium (CAC) identifies individuals at increased atherosclerotic cardiovascular disease (ASCVD) risk. Whether it can also identify individuals likely to derive net benefit from aspirin therapy is unclear.<br />Objective: To examine the association between CAC, bleeding, and ASCVD and explore the net estimated effect of aspirin at different CAC thresholds.<br />Design, Setting, and Participants: Prospective population-based cohort study of Dallas Heart Study participants, free from ASCVD and not taking aspirin at baseline. Data were analyzed between February 1, 2020, and July 15, 2020.<br />Exposures: Coronary artery calcium score in the following categories: 0, 1-99, and 100 or higher.<br />Main Outcomes and Measures: Major bleeding and ASCVD events were identified from International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. Meta-analysis-derived aspirin effect estimates were applied to observed ASCVD and bleeding rates to model the net effect of aspirin at different CAC thresholds.<br />Results: A total of 2191 participants (mean [SD], age 44 [9.1] years, 1247 women [57%], and 1039 black individuals [47%]) had 116 major bleeding and 123 ASCVD events over a median follow-up of 12.2 years. Higher CAC categories (CAC 1-99 and ≥100 vs CAC 0) were associated with both ASCVD and bleeding events (hazard ratio [HR], 1.6; 95% CI, 1.1-2.4; HR, 2.6; 95% CI, 1.5-4.3; HR, 4.8; 95% CI, 2.8-8.2; P < .001; HR, 5.3; 95% CI, 3.6-7.9; P < .001), but the association between CAC and bleeding was attenuated after multivariable adjustment. Applying meta-analysis estimates, irrespective of CAC, aspirin use was estimated to result in net harm in individuals at low (<5%) and intermediate (5%-20%) 10-year ASCVD risk and net benefit in those at high (≥20%) ASCVD risk. Among individuals at lower bleeding risk, a CAC score of at least 100 identified individuals who would experience net benefit, but only in those at borderline or higher (≥5%) 10-year ASCVD risk. In individuals at higher bleeding risk, there would be net harm from aspirin irrespective of CAC and ASCVD risk.<br />Conclusions and Relevance: Higher CAC is associated with both ASCVD and bleeding events, with a stronger association with ASCVD. A high CAC score identifies individuals estimated to derive net benefit from primary prevention aspirin therapy from those who would not, but only in the setting of lower bleeding risk and estimated ASCVD risk that is not low.
- Subjects :
- Adult
Cohort Studies
Eye Hemorrhage chemically induced
Eye Hemorrhage epidemiology
Female
Gastrointestinal Hemorrhage chemically induced
Gastrointestinal Hemorrhage epidemiology
Hemoptysis chemically induced
Hemoptysis epidemiology
Hemorrhage chemically induced
Hemorrhagic Stroke chemically induced
Hemorrhagic Stroke epidemiology
Humans
Intracranial Hemorrhages chemically induced
Intracranial Hemorrhages epidemiology
Male
Middle Aged
Patient Selection
Primary Prevention
Risk Assessment
Stroke epidemiology
Tomography, X-Ray Computed
Aspirin therapeutic use
Atherosclerosis prevention & control
Coronary Artery Disease diagnostic imaging
Coronary Disease mortality
Hemorrhage epidemiology
Myocardial Infarction epidemiology
Platelet Aggregation Inhibitors therapeutic use
Vascular Calcification diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 2380-6591
- Volume :
- 6
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- JAMA cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 33112372
- Full Text :
- https://doi.org/10.1001/jamacardio.2020.4939