Elevated CT CAC scores linked to future heart failure

By Abraham Kim, AuntMinnie.com staff writer

June 14, 2019 — The presence of coronary artery calcium (CAC) on the CT scans of middle-aged individuals, especially African Americans, was associated with an increased risk of structural heart abnormalities and future heart failure in a new study, published online June 14 in Circulation: Cardiovascular Imaging.

Over the past several years, multiple studies have confirmed the association between high CAC scores and cardiovascular disease. Recognizing this research, the American College of Cardiology (ACC) and American Heart Association (AHA) recently published a new guideline recommending CT CAC testing for individuals at risk of developing atherosclerotic heart disease.

Further adding to this work, researchers from the U.S. and Brazil tracked the cardiovascular health of 2,449 individuals as part of the Coronary Artery Risk Development in Young Adults (CARDIA) trial. The study participants were between 18 and 30 years old; they underwent a baseline CT CAC exam followed by subsequent CT CAC testing at 15 years and 25 years after the initial exam. Approximately half of them were African Americans, and 57% were women.

The researchers focused their study specifically on “early adulthood to middle-age because this is a window in which we can see abnormalities that might not be causing symptoms but could later increase the risk of heart problems,” co-author Dr. Henrique Moreira, PhD, from the University of São Paulo, said in a statement.

After analyzing the data, Moreira and colleagues found that individuals with positive CT CAC exams were more likely to have structural abnormalities in their heart’s left ventricle — a risk factor for heart failure — compared with those who had a negative CT CAC exam. CT CAC scores exceeding 0, for example, were associated with a 12% increase in left ventricular mass index and a 9% increase in left ventricular end-diastolic volume.

These structural abnormalities were particularly pronounced in African Americans, who had four times the increase in left ventricular mass for every single-digit increase in CT CAC score, compared with the cohort of white patients. Furthermore, the researchers identified a statistically significant association between an increase in CT CAC score between year 15 and year 25 and an increase in left ventricular mass — only in African Americans.

“Racial differences in our findings may be due to genetic factors or perhaps greater exposure to cardiovascular risk factors that usually appear earlier in blacks,” Moreira said. “We need more research to examine the link between coronary artery calcium and heart health.”

“The results of this study are important as they highlight that presence of CAC and higher CAC scores may also be associated with echocardiographic markers of subclinical left ventricular systolic and diastolic dysfunction. … [The results also] highlight the importance of primordial prevention and risk factor modification in early adulthood,” Dr. Salim Virani, from Baylor College of Medicine in Houston, said in response to the study.

Attention to Healthy Lifestyle at an Early Age Key to Preventing Heart Disease

By Reuters Staff

May 29, 2019

NEW YORK (Reuters Health) – Updated clinical practice guidelines on the management of blood cholesterol encourage adopting a heart-healthy lifestyle beginning in childhood to reduce lifetime risk for atherosclerotic cardiovascular disease (ASCVD), according to a new report.

The 78-page guideline from the American Heart Association (AHA), the American College of Cardiology (ACC) and other national associations was published in Circulation in November. To help disseminate the recommendations, Dr. Scott Grundy of the University of Texas Southwestern Medical Center in Dallas and colleagues now provide a six-page synopsis, published online May 27 in the Annals of Internal Medicine.

As a commentary (https://bit.ly/2QbHney) released with the guidelines in November noted, “Ultimately, the value of a guideline is determined by how effectively it is implemented into practice and by how much morbidity and mortality are avoided through its application.”

In addition to maintaining a healthy lifestyle over the lifespan, a theme stressed throughout the guideline, it advises:

– Maximally tolerated doses of statins in secondary prevention of ASCVD.

– Nonstatin medications (ezetimibe or pro-protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors) in addition to statin therapy for patients at very high risk for ASCVD.

– Statin therapy without risk stratification in severe primary hypercholesterolemia, often starting in childhood.

– Moderate-intensity statin therapy without risk stratification in adults aged 40 to 75 years with diabetes and an LDL cholesterol (LDL-C) level of 1.8 mmol/L (70 mg/dL) or higher.

– A risk discussion between the provider and patient about statin therapy for adults aged 40 to 75 years without diabetes who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL), and a 10-year ASCVD risk of 7.5% or higher.

– Moderate-intensity statin therapy if a risk discussion favors their use in adults aged 40 to 75 years without diabetes who have LDL-C levels of at least 1.8 mmol/L (70 mg/dL) and a 10-year ASCVD risk of 7.5% or higher.

– A three-tiered decision-making process in primary prevention in adults aged 40 to 75 years to personalize the risk decision. This includes enhancing factors such as family history of premature coronary artery disease metabolic syndrome, chronic kidney disease, LDL-C level 160 mg/dL or higher; and in women, history of pre-eclampsia or premature menopause (< 40 years); inflammatory diseases such as psoriasis, rheumatoid arthritis, HIV), and high-risk ethnicity such as South Asian ancestry.

– Coronary-artery-calcium scoring to improve risk stratification in moderate-risk patients for whom the benefits of statin therapy are uncertain.

– Follow-up for adherence to medications and lifestyle and to assess adequacy of response.

According to the Centers for Disease Control and Prevention, cardiovascular disease is the number one cause of death in the United States, including for African-American, Hispanic, and white persons and for both women and men.

The leading cause of death attributable to cardiovascular disease is coronary heart disease (44%), followed by stroke (17%). In 2013-2014, ASCVD accounted for 14% of total health expenditures, more than any other major diagnostic group.

SOURCE: https://bit.ly/2KbXENd

Ann Intern Med 2019.