title: CAC score as a possible criterion for administration of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers: the MultiEthnic Study of Atherosclerosis.
abstract: BACKGROUND
  Several trials have demonstrated that angiotensin converting enzyme inhibitors (ACEIs) decrease cardiovascular (CV) mortality rates in patients with heart failure; however, the Prevention of Events with Angiotensin-Converting Enzyme Inhibition (PEACE) and European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease (EUROPA) trials failed to show significant similar preventive effects in normal ejection fraction patients. We evaluated the baseline coronary artery calcium (CAC) score as a predictor of the effects of ACEIs/angiotensin receptor blockers (ARBs) on outcomes among normal ejection fraction participants.
  
  
  METHODS
  Of 6814 MultiEthnic Study for Atherosclerosis population participants (after exclusion of the patients temporarily using ACEIs and/or ARBs during follow-up), we evaluated 2906 participants who never used ACEIs/ARBs and 368 (8.7%) participants who constantly used them during all baseline and follow-up examinations. In the population studied, 53.9% were men, aged 60.8±10.0 years, who had no apparent clinical CV disease. We compared CV event rates and multivariable-adjusted hazard ratios after stratifying by ACEI/ARB use and stratifying CAC scores by category (0, 1-399, and ≥400).
  
  
  RESULTS
  The event rates varied from 1.8 to 41.2/1000 person years among the CAC groups. Among the participants with a 1-399 CAC score, ACEI/ARB users had significantly lower event rates than nonusers (4.9 vs. 8.2, respectively). Hazard ratio in the adjusted model was 3.1 (95% confidence interval 1.14-8.78, P<0.05). There was no significant event rate difference between ACEI/ARB users and nonusers among other CAC groups.
  
  
  CONCLUSIONS
  The use of ACEIs/ARBs was associated with significantly fewer CV events in asymptomatic participants with low to intermediate CAC scores. Thus, better risk stratification in asymptomatic individuals (such as using CAC scores) may assist in proper selection of patients for further CV risk reduction strategies.
authors.affiliation: aDepartment of Internal Medicine, Los Angeles Biomedical Research Institute, Torrance bDepartment of Internal Medicine, Irvine College of Medicine, University of California, Orange, California cDepartment of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine dDepartment of Internal Medicine, Bronx-Lebanon Hospital, Bronx, New York eDepartment of Internal Medicine, Baptist Health South Florida, Miami, Florida, USA fDepartment of Internal Medicine, Advanced Cardiodiagnostic Clinic, Ontario, Canada.
authors.forename: Sirous
authors.initials: S
authors.lastname: Darabian
authors.forename: Yanting
authors.initials: Y
authors.lastname: Luo
authors.forename: Arman
authors.initials: A
authors.lastname: Homat
authors.forename: Khashayar
authors.initials: K
authors.lastname: Khosraviani
authors.forename: Nathan
authors.initials: N
authors.lastname: Wong
authors.forename: Irfan
authors.initials: I
authors.lastname: Zeb
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology / Q000401:mortality; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors