Evidence map›Paper›PMID 26449135›Full record

Observational studyJournal of the American College of Cardiology2015

Implications of Coronary Artery Calcium Testing Among Statin Candidates According to American College of Cardiology/American Heart Association Cholesterol Management Guidelines: MESA (Multi-Ethnic Study of Atherosclerosis).

Khurram Nasir, Marcio S Bittencourt, Michael J Blaha, Ron Blankstein, Arthur S Agatson, Juan J Rivera, Michael D Miedema, Michael D Miemdema, Christopher T Sibley, Leslee J Shaw and 3 more

Erratum issuedOpen access · greenAbstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Journal of the American College of Cardiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 197 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
197citing papers in PubMed, 8 pooled it
45.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

197 citing papers in PubMed, 8 syntheses or guidelines pooled it, 463 citations in OpenAlex.

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137 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 8 institutions in 2 countries.

Khurram NasirCenter for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida; Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida. Electronic address: KhurramN@baptisthealth.net.
Marcio S BittencourtCenter for Clinical and Epidemiological Research and Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Preventive Medicine Centre, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Michael J BlahaThe Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
Ron BlanksteinNon-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Arthur S AgatsonCenter for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida.
Juan J RiveraMount Sinai Hospital, Miami Beach, Florida.
Michael D MiedemaMinneapolis Heart Institute Foundation, Minneapolis, Minnesota.
Michael D MiemdemaMinneapolis Heart Institute Foundation, Minneapolis, Minnesota.
Christopher T SibleyKnight Cardiovascular Institute, Oregon Health & Science University, Portland Oregon.
Leslee J ShawEmory Clinical Cardiovascular Research Institute, Emory University, Atlanta, Georgia.
Roger S BlumenthalThe Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
Matthew J BudoffDivision of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California.
Harlan M KrumholzSection of Cardiovascular Medicine and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
Baptist Hospital of Miami · USBrigham and Women's Hospital · USEmory University · USMinneapolis Heart Institute Foundation · USMount Sinai Hospital · USOregon Health & Science University · USThe Lundquist Institute · USYale New Haven Hospital · US

Funding

SUBCLINICAL CARDIOVASCULAR DISEASE COORDINATING CENTER-N01HC95159-268095159N01HC095159 · HC · UNIVERSITY OF WASHINGTON · PI KRONMAL, RICHARD A · 1999 to 2006
$304k
SUBCLINICAL CARDIOVASCULAR DISEASE STUDY--EBCT READINGN01HC095169 · HC · LA BIOMED RES INST/ HARBOR UCLA MED CTR · PI DETRANO, ROBERT · 1999 to 2001
$124k
NHLBI NIH HHS N01-HC-95159NHLBI NIH HHS N01-HC-95169
6 · The paper itself

Abstract

backgroundThe American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guidelines have significantly broadened the scope of candidates eligible for statin therapy.

objectivesThis study evaluated the implications of the absence of coronary artery calcium (CAC) in reclassifying patients from a risk stratum in which statins are recommended to one in which they are not.

methodsMESA (Multi-Ethnic Study of Atherosclerosis) is a longitudinal study of 6,814 men and women 45 to 84 years of age without clinical atherosclerotic cardiovascular disease (ASCVD) risk at enrollment. We excluded 1,100 participants (16%) on lipid-lowering medication, 87 (1.3%) without low-density lipoprotein levels, 26 (0.4%) with missing risk factors for calculation of 10-year risk of ASCVD, 633 (9%) >75 years of age, and 209 (3%) with low-density lipoprotein <70 mg/dl from the analysis.

resultsThe study population consisted of 4,758 participants (age 59 ± 9 years; 47% males). A total of 247 (5.2%) ASCVD and 155 (3.3%) hard coronary heart disease events occurred over a median (interquartile range) follow-up of 10.3 (9.7 to 10.8) years. The new ACC/AHA guidelines recommended 2,377 (50%) MESA participants for moderate- to high-intensity statins; the majority (77%) was eligible because of a 10-year estimated ASCVD risk ≥7.5%. Of those recommended statins, 41% had CAC = 0 and had 5.2 ASCVD events/1,000 person-years. Among 589 participants (12%) considered for moderate-intensity statin, 338 (57%) had a CAC = 0, with an ASCVD event rate of 1.5 per 1,000 person-years. Of participants eligible (recommended or considered) for statins, 44% (1,316 of 2,966) had CAC = 0 at baseline and an observed 10-year ASCVD event rate of 4.2 per 1,000 person-years.

conclusionsSignificant ASCVD risk heterogeneity exists among those eligible for statins according to the new guidelines. The absence of CAC reclassifies approximately one-half of candidates as not eligible for statin therapy.

Indexed as

EthnicityGuideline AdherenceAgedAged, 80 and overAmerican Heart AssociationAtherosclerosisCalciumCoronary AngiographyCoronary Artery DiseaseCoronary VesselsFemaleFollow-Up StudiesHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedCalciumHydroxymethylglutaryl-CoA Reductase Inhibitorsatherosclerosischolesterolhydroxymethylglutaryl-CoA reductase inhibitorsrisk assessment

Identifiers

PMID26449135
OpenAlexW1821026158

What OpenQuestion holds

Texttitle and abstract
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.