title: Polypill therapy, subclinical atherosclerosis, and cardiovascular events-implications for the use of preventive pharmacotherapy: MESA (Multi-Ethnic Study of Atherosclerosis).
abstract: OBJECTIVE
  This study examines whether the coronary artery calcium (CAC) score can be used to define the target population to treat with a polypill.
  
  
  BACKGROUND
  Prior studies have suggested a single polypill to reduce cardiovascular disease (CVD) at the population level.
  
  
  METHODS
  Participants from MESA (Multi-Ethnic Study of Atherosclerosis) were stratified using the criteria of 4 polypill studies (TIPS [The Indian Polycap Study], Poly-Iran, Wald, and the PILL [Program to Improve Life and Longevity] Collaboration). We compared coronary heart disease (CHD) and CVD event rates and calculated the 5-year number needed to treat (NNT) after stratification based on the CAC score.
  
  
  RESULTS
  Among MESA participants eligible for TIPS, Poly-Iran, Wald, and the PILL Collaboration, CAC = 0 was observed in 58.6%, 54.5%, 38.9%, and 40.8%, respectively. The rate of CHD events among those with CAC = 0 varied from 1.2 to 1.9 events per 1,000 person-years, those with CAC scores from 1 to 100 had event rates ranging from 4.1 to 5.5, and in those with CAC scores >100 the event rate ranged from 11.6 to 13.3. The estimated 5-year NNT to prevent 1 CVD event ranged from 81-130 for patients with CAC = 0, 38-54 for those with CAC scores from 1 to 100, and 18-20 for those with CAC scores >100.
  
  
  CONCLUSIONS
  In MESA, among individuals eligible for treatment with the polypill, the majority of CHD and CVD events occurred in those with CAC scores >100. The group with CAC = 0 had a very low event rate and a high projected NNT. The avoidance of treatment in individuals with CAC = 0 could allow for significant reductions in the population considered for treatment, with a more selective use of the polypill and, as a result, avoidance of treatment in those who are unlikely to benefit.
authors.affiliation: Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Márcio Sommer
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Non-Invasive Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Division of Cardiology, Los Angeles Biomedical Research Institute at Harbour-UCLA, Torrance, California.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: Cardiology Division, Johns Hopkins Hospital, Baltimore, Maryland; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.
authors.forename: Jose D
authors.initials: JD
authors.lastname: Vargas
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Agatston
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland; Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida; Baptist Cardiovascular Institute, Baptist Health South Florida, Miami, Florida. Electronic address: knasir1@jhmi.edu.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D002114:Calcinosis / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D002118:Calcium / Q000378:metabolism*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D003331:Coronary Vessels / Q000378:metabolism*; D004359:Drug Therapy, Combination; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D002118:Calcium
keywords: CAC; CHD; CVD; FRS; Framingham risk score; HR; NNT; cardiovascular disease; coronary artery calcium; coronary heart disease; hazard ratio; number needed to treat; polypill; risk stratification; subclinical atherosclerosis