title: Guideline-based statin/lipid-lowering therapy eligibility for primary prevention and accuracy of coronary artery calcium and clinical cardiovascular events: The Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: BACKGROUND
  With multiple cholesterol guidelines, we evaluated the accuracy of recommended statin therapy on identifying coronary artery calcium (CAC) and cardiovascular disease (CVD) events by 2004 NCEP/ ATP III, 2016 ESC/EAS, and 2013 ACC/AHA guidelines.
  
  
  OBJECTIVE
  ACC/AHA guidelines are more accurate in identifying persons at risk for CVD.
  
  
  METHODS
  5002/6814 participants age <75 years and free of CVD were included. CAC categories (>0, ≥100, and ≥300) and 10 years of CVD outcomes were considered. Sensitivity (SN), specificity (SP), positive and negative predictive value (PPV and NPV), and likelihood ratios (LR) were calculated. Mean age was 59 years; 47% of subjects were males.
  
  
  RESULTS
  1297 (26%), 1381 (28%), and 2538 (51%) had class I indications for statin/LLT by the NCEP ATP III, ESC/EAS, and AHA/ACC guidelines, respectively. SN, SP, NPV, and PPV for CAC ≥300 were: NCEP ATP III (41.1%, 75.5%, 93.3% and 13.4%), ESC/EAS (54.1%, 74.8%, 94.6% and16.6%), and ACC/AHA (87.2%, 52.6%, 97.8% and 14.5%). SN, SP, PPV, and NPV for corresponding CVD outcomes were: NCEP ATP III (45.8%, 75.1%, 96.3%, and 8.9%), ESC/EAS (50.5%, 72.9%, 98.7%, and 3.6%), and AHA/ACC (79.6%, 50.7%, 98%, and 7.7%). ESC/EAS had significantly higher positive LR 2.15 (95% CI, 1.95 - 2.38) and ACC/AHA had significantly lower negative LR [0.24, (95% CI 0.19 - 0.31)] for corresponding CVD.
  
  
  CONCLUSIONS
  Despite the increased in SN of statin eligibility by the ACC/AHA, it has similar NPV and PPV for CAC/future CVD events. The ACC/AHA class I indications for statin may be a superior screening tool for subclinical and clinical CVD.
authors.affiliation: Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Peter
authors.initials: P
authors.lastname: Flueckiger
authors.affiliation: Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Waqas
authors.initials: W
authors.lastname: Qureshi
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.affiliation: Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Blaha
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Gregory
authors.initials: G
authors.lastname: Burke
authors.affiliation: Radiology and Imaging Services, National Institutes of Health, Bethesda, Maryland.
authors.forename: Veit
authors.initials: V
authors.lastname: Sandfort
authors.affiliation: Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: David
authors.initials: D
authors.lastname: Herrington
authors.affiliation: Heart and Vascular Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Joseph
authors.initials: J
authors.lastname: Yeboah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D050197:Atherosclerosis / Q000188:drug therapy* / Q000208:ethnology / Q000378:metabolism; D002118:Calcium / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000208:ethnology / Q000378:metabolism / Q000517:prevention & control*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000378:metabolism; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002118:Calcium
keywords: General clinical cardiology/adult; Preventive cardiology; cardiovascular guidelines; computed tomography < Imaging; coronary artery calcium score