Background and aims

Coronary artery calcium (CAC) may encourage patients to adhere to primary prevention recommendations. This study sought to evaluate the benefit of a CAC-guided risk-management protocol in those with a family history of premature coronary artery disease (FHCAD).

Methods

In this Australian multi-centre, randomized controlled trial (Coronary Artery Calcium score: Use to Guide management of Hereditary Coronary Artery Disease, CAUGHT-CAD), asymptomatic, statin-native participants at low-intermediate cardiovascular risk with FHCAD underwent CAC assessment. Those with CAC between 1 and 400 were randomized (1:1) to disclosing the CAC result to both patient and physician and commencing atorvastatin (intervention) or blinding the CAC result with risk factor education only (control). The primary endpoint of this sub-study was change in Pooled Cohort Equation (PCE) at 12 months.

Results

Of 1088 participants who were scanned, 450 were randomised and 214 in both groups completed 1-year follow-up. At 1 year, PCE-risk decreased by 1.0% (95% CI 0.13 to 1.81) in the CAC-disclosed group and increased by 0.43% (95%CI 0.11–0.75) in the CAC-blinded group. LDL-C decreased in the CAC-disclosed group in both those who continued (1.5 mmol/L; 95% CI 1.36 to 1.74) and discontinued statins (0.62 mmol/L; 95% CI 0.32 to 0.92) but was unchanged in the CAC-blinded group.

Conclusion

Participants unblinded to their CAC showed reductions in LDL irrespective of statin continuation when compared to controls at 12 months. Improvements in individual risk factors and PCE risk were also noted. CAC assessment may positively influence patients and physicians to improve risk factor control.

中文翻译：

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冠状动脉钙引导他汀类药物治疗方案对 12 个月心血管风险的影响：一项实用随机对照试验的结果

背景和目标

冠状动脉钙化 (CAC) 可能会鼓励患者遵守一级预防建议。本研究旨在评估 CAC 指导的风险管理方案对有早发性冠状动脉疾病 (FHCAD) 家族史的人的益处。

方法

在这项澳大利亚多中心、随机对照试验（冠状动脉钙化评分：用于指导遗传性冠状动脉疾病的管理，CAUGHT-CAD）中，患有 FHCAD 的中低心血管风险的无症状他汀类药物参与者接受了 CAC 评估。CAC 介于 1 和 400 之间的患者被随机 (1:1) 向患者和医生披露 CAC 结果并开始使用阿托伐他汀（干预）或仅通过风险因素教育对 CAC 结果进行盲法（对照）。该子研究的主要终点是 12 个月时合并队列方程 (PCE) 的变化。

结果

在接受扫描的 1088 名参与者中，450 名被随机分配，两组中有 214 名完成了 1 年的随访。在 1 年时，CAC 披露组的 PCE 风险降低了 1.0%（95% CI 0.13 至 1.81），而 CAC 盲法组的 PCE 风险增加了 0.43%（95% CI 0.11-0.75）。在 CAC 公开组中，继续（1.5 mmol/L；95% CI 1.36 至 1.74）和停用他汀类药物（0.62 mmol/L；95% CI 0.32 至 0.92）的患者的 LDL-C 均降低，但 CAC 未发生变化- 盲组。

结论

与对照组相比，在 12 个月时与对照组相比，未对其 CAC 设盲的参与者显示出 LDL 降低，而不管他汀类药物是否继续使用。还注意到个人风险因素和 PCE 风险的改善。CAC 评估可能会对患者和医生产生积极影响，以改善风险因素控制。