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Statin therapy for primary prevention in men: What is the role for coronary artery calcium?

  • Scott M. Grundy
    Correspondence
    Corresponding author. Scott M. Grundy, M.D., Ph.D, Professor of Internal Medicine, Center for Human Nutrition, 5323 Harry Hines Blvd., Dallas, Texas 75390-9014
    Affiliations
    Departments of Internal Medicine

    Center for Human Nutrition of the University of Texas Southwestern Medical Center at Dallas, Texas

    The Veterans Administration Medical Center at North Texas Healthcare System at Dallas, Texas
    Search for articles by this author
  • Jijia Wong
    Affiliations
    Applied Clinical Research
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  • Gloria L. Vega
    Affiliations
    Clinical Nutrition

    Center for Human Nutrition of the University of Texas Southwestern Medical Center at Dallas, Texas

    The Veterans Administration Medical Center at North Texas Healthcare System at Dallas, Texas
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Published:November 23, 2022DOI:https://doi.org/10.1016/j.jacl.2022.11.001

      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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