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Impact of lipid-lowering therapies on cardiovascular outcomes according to coronary artery calcium score. A systematic review and meta-analysis
- Source :
- Revista Española de Cardiología (English Edition). 75:506-514
- Publication Year :
- 2022
- Publisher :
- Elsevier BV, 2022.
-
Abstract
- Introduction and objectives Coronary artery calcium (CAC) score improves the accuracy of risk stratification for atherosclerotic cardiovascular disease (ASCVD) events compared with traditional cardiovascular risk factors. We evaluated the interaction of coronary atherosclerotic burden as determined by the CAC score with the prognostic benefit of lipid-lowering therapies in the primary prevention setting. Methods We reviewed the MEDLINE, EMBASE, and Cochrane databases for studies including individuals without a previous ASCVD event who underwent CAC score assessment and for whom lipid-lowering therapy status stratified by CAC values was available. The primary outcome was ASCVD. The pooled effect of lipid-lowering therapy on outcomes stratified by CAC groups (0, 1-100, > 100) was evaluated using a random effects model. Results Five studies (1 randomized, 2 prospective cohort, 2 retrospective) were included encompassing 35 640 individuals (female 38.1%) with a median age of 62.2 [range, 49.6-68.9] years, low-density lipoprotein cholesterol level of 128 (114-146) mg/dL, and follow-up of 4.3 (2.3-11.1) years. ASCVD occurrence increased steadily across growing CAC strata, both in patients with and without lipid-lowering therapy. Comparing patients with (34.9%) and without (65.1%) treatment exposure, lipid-lowering therapy was associated with reduced occurrence of ASCVD in patients with CAC > 100 (OR, 0.70; 95%CI, 0.53-0.92), but not in patients with CAC 1-100 or CAC 0. Results were consistent when only adjusted data were pooled. Conclusions Among individuals without a previous ASCVD, a CAC score > 100 identifies individuals most likely to benefit from lipid-lowering therapy, while undetectable CAC suggests no treatment benefit.
- Subjects :
- medicine.medical_specialty
MEDLINE
Coronary Artery Disease
Risk Assessment
Puntuación de calcio coronario
Tratamiento hipolipemiante
Risk Factors
Internal medicine
Primary prevention
medicine
Humans
Prospective Studies
Prevención primaria
Vascular Calcification
Prospective cohort study
Aged
Retrospective Studies
Atherosclerotic cardiovascular disease
Coronary artery calcium score
Enfermedad cardiovascular ateroesclerótica
Lipid lowering therapy
Meta-analysis
Metanálisis
business.industry
nutritional and metabolic diseases
General Medicine
Middle Aged
Atherosclerosis
Coronary Vessels
Lipids
Calcium
Female
Lipid lowering
business
Cardiovascular outcomes
Subjects
Details
- ISSN :
- 18855857
- Volume :
- 75
- Database :
- OpenAIRE
- Journal :
- Revista Española de Cardiología (English Edition)
- Accession number :
- edsair.doi.dedup.....a7a52dfa89cdcdb4d60a5338906373b8