From the Guidelines
Statins are recommended for patients with high coronary computed tomography angiography (CTA) calcium scores, specifically those with scores of 100 or higher or in the 75th percentile or higher, as they can help reduce cardiovascular risk in these individuals. According to the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol, statin therapy is reasonable for patients with high calcium scores, particularly those aged 55 years or older 1. The guideline suggests that if the coronary calcium score is 1 to 99, statin therapy may be considered for patients aged 55 years or older, while a score of zero may warrant withholding statin therapy and reassessing in 5 to 10 years, provided higher risk conditions are absent 1.
Key considerations for initiating statin therapy in patients with high calcium scores include:
- Age: 55 years or older
- Calcium score: 100 or higher or in the 75th percentile or higher
- Presence of other risk factors: diabetes mellitus, family history of premature CHD, cigarette smoking
- Overall cardiovascular risk profile
It is essential to perform a comprehensive risk assessment, including lipid panel, blood pressure measurement, and evaluation of other cardiovascular risk factors, to determine the appropriateness of statin therapy for individual patients 1. By considering these factors and guidelines, clinicians can make informed decisions about statin therapy for patients with high coronary CTA calcium scores, ultimately reducing their cardiovascular risk.
From the Research
Statins and Cardiovascular Risk Reduction
- Statins, or HMG-CoA reductase inhibitors, have been shown to reduce cardiovascular risk in patients with high coronary computed tomography angiography (CTA) calcium scores 2, 3, 4, 5, 6.
- The St Francis Heart Study found that statin therapy reduced cardiovascular events in patients with high CAC scores, with a 10-year event rate of less than 1 per 100 person-years in patients with low CAC scores (<100) and a high 10-year event rate (≥17 per 100 person-years) in patients with high CAC scores (>300) 2.
- A review of the US and European literature found that high-intensity statins are recommended for patients at high risk for atherosclerotic cardiovascular disease (ASCVD), including those with high CAC scores 3.
- The use of CAC scoring has been shown to improve cardiovascular risk stratification and guide decisions to start statin therapy in people living with HIV 6.
CAC Scores and Statin Therapy
- CAC scores can be used to identify patients who may benefit from statin therapy, with higher scores indicating a higher risk of cardiovascular events 2, 4, 5, 6.
- A systematic review and meta-analysis found that statins slowed down CAC progression mildly but with statistical significance in populations with baseline CAC scores >400 5.
- The combination of conventional risk tools and CAC scoring has been shown to improve risk assessment and the selection of patients who would benefit from statin therapy 6.
Clinical Implications
- Statin therapy should be considered in patients with high CAC scores, as it has been shown to reduce cardiovascular risk 2, 3, 4, 5, 6.
- CAC scoring can be used to guide decisions to start statin therapy, particularly in patients with high-risk profiles 3, 4, 6.
- Further studies are needed to fully understand the relationship between CAC progression under statin therapy and cardiovascular outcomes 5.