Highlights
- •Statins reduce atherosclerotic cardiovascular disease in men and women.
- •Men develop coronary atherosclerosis more rapidly than women.
- •Most men 55 to 75 years are statin eligible by Pooled Cohort Equations.
- •But statin eligibility may be better guided by coronary artery calcium (CAC).
Abstract
Current cholesterol guidelines for primary prevention of atherosclerotic cardiovascular
disease (ASCVD) base statin treatment decisions on multiple risk factor algorithms
(e.g., Pooled Cohort Equations [PCEs]). By available PCEs, most older middle-aged
men are statin eligible. But several studies cast doubt on predictive accuracy of
available PCEs for ASCVD risk assessment. Recent studies suggest that accuracy can
be improved by measurement of coronary artery calcium (CAC). This method has the advantage
of identifying men at low risk in whom statin therapy can be delayed for several years,
provided they are monitored periodically for progression of CAC. Thus, there are two
approaches to statin therapy in men ≥ 55 years: first all men could be treated routinely,
or second, treatment can be based on the extent of coronary calcium. The latter could
allow a sizable fraction of men to avoid treatment for several years or indefinitely.
Whether with initial CAC scan or with periodic rescanning, a CAC score ≥ 100 Agatston
units is high enough to warrant statin therapy. In otherwise high-risk men (e.g.,
diabetes, severe hypercholesterolemia, 10-year risk by PCE ≥ 20%), a statin is generally
indicated without the need for CAC; but in special cases, CAC measurement may aid
in treatment decisions.
Keywords
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Article info
Publication history
Published online: November 23, 2022
Accepted:
November 9,
2022
Received:
May 31,
2022
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of National Lipid Association.
