title: Motivational effects of coronary artery calcium scores on statin adherence and weight loss.
abstract: OBJECTIVE
  The aim of this study was to assess the effect on adherence to statin therapy and assess the effect of beneficial changes in behavior that resulted in weight loss in patients who underwent coronary artery calcium (CAC) scoring with cardiac computed tomography.
  
  
  BACKGROUND
  Despite convincing data demonstrating the benefits of HmGCoA inhibitors for both primary and secondary prevention of coronary heart disease, they remain underused. Also, despite convincing data demonstrating the benefits of weight loss for both primary and secondary prevention of coronary heart disease, it remains difficult to motivate behavioral changes resulting in weight loss. In this study, we assess whether higher CAC scores are associated with increased compliance with statin medication and whether higher CAC scores are associated with beneficial lifestyle behaviors resulting in weight loss.
  
  
  METHODS
  We retrospectively analyzed patients that had undergone baseline CAC testing and returned for a follow-up scan. All patients had weight documented and were administered a questionnaire regarding compliance to medications. The primary endpoint was measurable weight loss between visit one and visit two and the self-reported compliance to statin use.
  
  
  RESULTS
  The study population with data regarding statin compliance consisted of 2608 individuals (72% men, mean age 58±8 years) who were followed for a mean of 4.1±3.2 years after an initial CAC scan. Overall, statin compliance was lowest (27.4%) among those with CAC=0, and gradually increased with higher CAC scores (1-99, 39.2%; 100-399, 53.6%; ≥400, 58.8%; P<0.001 for trend). In the group analyzed for weight loss the study population consisted of 1078 individuals (68% men, mean age 60±8 years) who were followed for a mean of 4.1±3.2 years after an initial CAC scan.
  
  
  CONCLUSIONS
  Overall, behavioral modification resulting in weight loss was lowest (19.8%) among those with CAC=0, and gradually increased with higher CAC scores (1-99, 23.4%; 100-399, 30.8%; ≥400, 33.6%; P<0.001 for trend). In addition to being a robust risk stratification tool, a higher rate of adherences with statin therapy was observed in patients with higher CAC scores.
authors.affiliation: Department of Internal Medicine, LA Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA.
authors.forename: Nove K
authors.initials: NK
authors.lastname: Kalia
authors.forename: Lucas
authors.initials: L
authors.lastname: Cespedes
authors.forename: George
authors.initials: G
authors.lastname: Youssef
authors.forename: Dong
authors.initials: D
authors.lastname: Li
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D050171:Dyslipidemias / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D009765:Obesity / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D015431:Weight Loss
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors