Impact of low/no-charge coronary artery calcium scoring on statin eligibility and outcomes in women: The CLARIFY study.
Impact of low/no-charge coronary artery calcium scoring on statin eligibility and outcomes in women: The CLARIFY study.
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DOI：
10.1016/j.ajpc.2022.100392
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发表时间：
2022-12
影响因子：
4.1
通讯作者：
Rajagopalan, Sanjay
中科院分区：
文献类型：
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作者：
Al-Kindi, Sadeer;Tashtish, Nour;Rashid, Imran;Sullivan, Claire;Neeland, Ian J;Robinson, Monique;Gross, Ewa M;Shaw, Leslee;Cainzos-Achirica, Miguel;Nasir, Khurram;Kreatsoulas, Catherine;Gilkeson, Robert;Simon, Daniel I;Rajagopalan, Sanjay
先前的研究表明，他汀类药物在女性中的应用明显不足，心血管预后更差。研究真实冠状动脉钙（CAC）评分对提高预防治疗和预后的影响的数据有限。在一项2014年至2019年间低成本或无成本CAC评分的前瞻性登记研究中（clarestudy, Clinicaltrials.gov NCT04075162），我们试图研究CAC评分与他汀类药物使用、血脂（LDL、总胆固醇、甘油三酯）、下游缺血测试（冠状动脉造影和应激测试）、冠状动脉血运重建和结局（心肌梗死、中风、死亡）在女性和男性中的相关性。他汀类药物起始治疗的资格定义为：动脉粥样硬化性心血管疾病合并队列方程(ASCVD-PCE)≥7.5%，CAC≥100/≥75百分位。共纳入52,151例患者（26,336例女性和25,815例男性）。女性患CAC 0的可能性更高（51% vs 30%， P<0.001）。在不符合PCE的他汀类药物患者中，CAC对他汀类药物资格重新分类的女性比例小于男性（25.4%对30%，P<0.001），而在符合PCE的他汀类药物患者中，CAC更有可能降低女性的风险/他汀类药物资格（30.1%对48.4%，P<0.001）。在CAC评分后，他汀类药物的起始量在男性和女性中相似，但高强度他汀类药物的使用在女性中较低（CAC校正HR 0.76 [0.70-0.83]， P<0.001）。与男性相比，女性的低密度脂蛋白胆固醇水平也有类似的下降。在cac分层的主要不良心血管事件方面，男性和女性没有差异。与男性相比，CAC评分主要用于降低女性服用他汀类药物的资格。与男性相比，女性在CAC风险引导下的低密度脂蛋白胆固醇降低程度相似。
Prior studies have suggested significant underutilization of statins in women and worse cardiovascular outcomes. Data examining the impact of real-world coronary artery calcium (CAC) scoring to improve utilization of preventive therapies and outcomes is limited. In a prospective registry study of low cost or no-cost CAC scoring between 2014 and 19 (CLARIFY Study, Clinicaltrials.gov NCT04075162), we sought to study the association of CAC scoring on statin utilization, blood lipids (LDL, total cholesterol, triglycerides), downstream ischemic testing (coronary angiography and stress testing), coronary revascularization and outcomes (MI, stroke, death) in women compared with men. Eligibility for statin initiation was defined as atherosclerotic cardiovascular disease pooled cohort equation (ASCVD-PCE) ≥ 7.5% and CAC≥100/≥75th percentile. A total of 52,151 patients (26,336 women and 25,815 men) were enrolled. Women were more likely to have CAC 0 (51% vs 30%, P<0.001). Among patients not eligible for statin by PCE, CAC reclassified statin eligibility in a smaller proportion of women than men (25.4% vs 30%, P<0.001), while among patients eligible for statin by PCE, CAC was more likely to downgrade risk/statin eligibility in women than men (30.1% vs 48.4%, P<0.001). After CAC scoring, statin initiation was similar in women and men, but high-intensity statin use was lower in women (CAC-adjusted HR 0.76 [0.70–0.83], P<0.001). Women had similar reduction in LDL cholesterol levels compared with men. There was no difference between men and women with respect to CAC-stratified major adverse cardiovascular events. CAC scoring primarily served to downgrade statin eligibility in women compared with men. Women had similar CAC risk-guided reductions in LDL cholesterol compared with men. .