title: Coronary artery calcium in relation to initiation and continuation of cardiovascular preventive medications: The Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  Whether measuring and reporting of coronary artery calcium scores (CACS) might lead to changes in cardiovascular risk management is not established. In this observational study, we examined whether high baseline CACS were associated with the initiation as well continuation of new lipid-lowering medication (LLM), blood pressure-lowering medication (BPLM), and regular aspirin (ASA) use in a multi-ethnic population-based cohort.
  
  
  RESULTS
  The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of 6814 participants free of clinical cardiovascular disease at entry who underwent CAC testing at baseline examination (examination 1). Information on LLM, BPLM, and regular ASA usage was also obtained at baseline and at exams 2 and 3 (average of 1.6 and 3.2 years after baseline, respectively). In this study, we examined (1) initiation of these medications at examination 2 among participants not taking these medications at baseline; and (2) continuation of medication use to examination 3 among participants already on medication at baseline. Among MESA participants, initiation of LLM, BPLM, and ASA was greater in those with higher CACS. After taking into account age, sex, race, MESA site, LDL cholesterol, diabetes mellitus, body mass index, smoking status, hypertension, systolic blood pressure, and socioeconomic status (income, education, and health insurance), the risk ratios for medication initiation comparing those with CACS >400 versus CACS=0 were 1.53 (95% confidence interval [CI], 1.08, 2.15) for LLM, 1.55 (95% CI, 1.10 to 2.17) for BPLM, and 1.32 (95% CI, 1.03 to 1.69) for ASA initiation, respectively. The risk ratios for medication continuation among those with CAC >400 versus CACS=0 were 1.10 (95% CI, 1.01 to 1.20) for LLM, 1.05 (95% CI, 1.02 to 1.08) for BPLM, and 1.14 (95% CI, 1.04 to 1.25) for ASA initiation, respectively.
  
  
  CONCLUSIONS
  CACS >400 was associated with a higher likelihood of initiation and continuation of LLM, BPLM, and ASA. The association was weaker for continuation than for initiation of these preventive therapies.
authors.affiliation: Ciccarone Preventive Cardiology Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. knasir1@jhmi.edu <knasir1@jhmi.edu>
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control*; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy* / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012308:Risk Management; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin; D002118:Calcium