CAC for Risk Stratification Among Individuals With Hypertriglyceridemia Free of Clinical Atherosclerotic Cardiovascular Disease

• Published in: JACC. Cardiovascular imaging 2022-04, Vol.15 (4), p.641-651
• Main Authors: Cainzos-Achirica, Miguel, Quispe, Renato, Dudum, Ramzi, Greenland, Philip, Lloyd-Jones, Donald, Rana, Jamal S., Lima, Joao A.C., Doria de Vasconcellos, Henrique, Joshi, Parag H., Khera, Amit, Ayers, Colby, Erbel, Raimund, Stang, Andreas, Jöckel, Karl-Heinz, Lehmann, Nils, Schramm, Sara, Schmidt, Börge, Toth, Peter P., Patel, Kershaw V., Blaha, Michael J., Bittencourt, Marcio, Nasir, Khurram
• Format: Article
• Language: English
• Subjects: Atherosclerosis - diagnostic imaging; Atherosclerosis - drug therapy; Atherosclerosis - epidemiology; cardiovascular disease; Cardiovascular Diseases - epidemiology; coronary artery calcium; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - drug therapy; Coronary Artery Disease - epidemiology; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; hypertriglyceridemia; Hypertriglyceridemia - diagnosis; Hypertriglyceridemia - drug therapy; Hypertriglyceridemia - epidemiology; icosapent ethyl; Predictive Value of Tests; prevention; primary prevention; risk; Risk Assessment; Risk Factors; Vascular Calcification - diagnostic imaging; Vascular Calcification - drug therapy; Vascular Calcification - epidemiology
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2021.10.017

In this study, we sought to evaluate whether the coronary artery calcium (CAC) score can enhance current paradigms for risk stratification among individuals with hypertriglyceridemia in primary prevention. The eligibility criteria for icosapent ethyl (IPE) were used as case example. Recent trials of atherosclerotic cardiovascular disease (ASCVD) risk-reduction therapies for individuals with hypertriglyceridemia without clinical ASCVD restricted enrollment to participants with diabetes or various other risk factors. These criteria were mirrored in the Food and Drug Administration product label for IPE. We pooled 2,345 participants with triglycerides 150 to 178-0-100, >100). The number needed to treat for 5 years (NNT5) to prevent 1 event was estimated among IPE-eligible participants, assuming a 21.8% relative risk reduction with IPE. In exploratory analyses, the NNT5 was also estimated among noneligible participants. There was marked heterogeneity in CAC burden overall (45% CAC 0; 24% CAC >100) and across IPE eligibility strata. Overall, 17% of participants were eligible for IPE and 11.9% had ASCVD events within 5 years. Among participants eligible for IPE, 38% had CAC >100, and their event rates were markedly higher (15.9% vs 7.2%) and the NNT5 2.2-fold lower (29 vs 64) than those of the 25% eligible participants with CAC 0. Among the 83% participants not eligible for IPE, 20% had CAC >100, and their 5-year incidence of ASCVD (13.9%) was higher than the overall incidence among IPE-eligible participants. CAC can improve current risk stratification and therapy allocation paradigms among individuals with hypertriglyceridemia without clinical ASCVD. Future trials of risk-reduction therapies in hypertriglyceridemia could use CAC >100 to enroll a high-risk study sample, with implications for a larger target population. [Display omitted]