title: Coronary artery disease detected by coronary computed tomographic angiography is associated with intensification of preventive medical therapy and lower low-density lipoprotein cholesterol.
abstract: BACKGROUND
  Coronary computed tomographic angiography (CCTA) is an accurate test for the identification of coronary artery disease (CAD), yet the impact of CCTA results on subsequent medical therapy and risk factors has not been widely reported.
  
  
  RESULTS
  We identified consecutive patients aged >18 years without prior CAD who underwent CCTA from 2004 to 2011 and had complete data on medications before and after CCTA. CCTA results were categorized as no CAD, <50% stenosis, and ≥50% stenosis. Based on the number of involved segments, extent of disease was categorized as nonextensive (≤4 segments) or extensive CAD (>4 segments). Electronic medical records and patient interviews were reviewed blinded to CCTA findings to assess initiation of aspirin and intensification of lipid-lowering therapies. Survival analysis was performed to evaluate intensification of lipid therapy as a predictor of cardiovascular death or nonfatal myocardial infarction. Among 2839 patients with mean follow-up of 3.6 years, the odds of physician intensification of lipid-lowering therapy significantly increased for those with nonobstructive CAD (odds ratio, 3.6; 95% confidence interval, 2.9-4.9; P<0.001) and obstructive CAD (odds ratio, 5.6; 95% confidence interval, 4.3-7.3; P<0.001). Low-density lipoprotein cholesterol levels declined significantly in association with intensification of lipid-lowering therapy after CCTA in all patient subgroups. In a hypothesis-generating analysis, among patients with nonobstructive but extensive CAD, statin use after CCTA was associated with a reduction in cardiovascular death or myocardial infarction (hazards ratio, 0.18; 95% confidence interval, 0.05-0.66; P=0.01).
  
  
  CONCLUSIONS
  Abnormal CCTA findings are associated with downstream intensification in statin and aspirin therapy. In particular, CCTA may lead to increased use of prognostically beneficial therapies in patients identified as having extensive, nonobstructive CAD.
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Edward
authors.initials: E
authors.lastname: Hulten
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Marcio Sommer
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Avinainder
authors.initials: A
authors.lastname: Singh
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Daniel
authors.initials: D
authors.lastname: O'Leary
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Mitalee P
authors.initials: MP
authors.lastname: Christman
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Wafa
authors.initials: W
authors.lastname: Osmani
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steigner
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Quynh A
authors.initials: QA
authors.lastname: Truong
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Frank F
authors.initials: FF
authors.lastname: Rybicki
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Josh
authors.initials: J
authors.lastname: Klein
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Jon
authors.initials: J
authors.lastname: Hainer
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Brady
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Brian B
authors.initials: BB
authors.lastname: Ghoshhajra
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Rory
authors.initials: R
authors.lastname: Hachamovitch
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
authors.affiliation: From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.). rblankstein@partners.org.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
mesh_terms: D001241:Aspirin / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: aspirin; prevention and control; prognosis