title: Assessment of Coronary Artery Calcium Scoring for Statin Treatment Strategy according to ACC/AHA Guidelines in Asymptomatic Korean Adults.
abstract: OBJECTIVE
  The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guidelines advocate the use of statin treatment for prevention of cardiovascular disease. We aimed to assess the usefulness of coronary artery calcium (CAC) for stratifying potential candidates of statin use among asymptomatic Korean individuals.
  
  
  METHODS
  A total of 31375 subjects who underwent CAC scoring as part of a general health examination were enrolled in the current study. Statin eligibility was categorized as statin recommended (SR), considered (SC), and not recommended (SN) according to ACC/AHA guidelines. Cox regression analysis was employed to estimate hazard ratios (HR) with 95% confidential intervals (CI) after stratifying the subjects according to CAC scores of 0, 1-100, and >100. Number needed to treat (NNT) to prevent one mortality event during study follow up was calculated for each group.
  
  
  RESULTS
  Mean age was 54.4±7.5 years, and 76.3% were male. During a 5-year median follow-up (interquartile range; 3-7), there were 251 (0.8%) deaths from all-causes. A CAC >100 was independently associated with mortality across each statin group after adjusting for cardiac risk factors (e.g., SR: HR, 1.60; 95% CI, 1.07-2.38; SC: HR, 2.98; 95% CI, 1.09-8.13, and SN: HR, 3.14; 95% CI, 1.08-9.17). Notably, patients with CAC >100 displayed a lower NNT in comparison to the absence of CAC or CAC 1-100 in SC and SN groups.
  
  
  CONCLUSIONS
  In Korean asymptomatic individuals, CAC scoring might prove useful for reclassifying patient eligibility for receiving statin therapy based on updated 2013 ACC/AHA guidelines.
authors.affiliation: Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, Korea.|Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
authors.forename: Donghee
authors.initials: D
authors.lastname: Han
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
authors.forename: Bríain
authors.initials: B
authors.lastname: Ó Hartaigh
authors.affiliation: Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, Korea.|Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
authors.forename: Asim
authors.initials: A
authors.lastname: Rizvi
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyo Eun
authors.initials: HE
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Su Yeon
authors.initials: SY
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Heart Stroke & Vascular Institute, Samsung Medical Center, Seoul, Korea.
authors.forename: Jidong
authors.initials: J
authors.lastname: Sung
authors.affiliation: Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University Health System, Seoul, Korea. hjchang@yuhs.ac.
authors.forename: Hyuk Jae
authors.initials: HJ
authors.lastname: Chang
mesh_terms: D000368:Aged; D000572:American Heart Association; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002423:Cause of Death; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D061366:Numbers Needed To Treat; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D061205:Vascular Calcification / Q000175:diagnosis*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Coronary artery disease; calcium; hydroxymethylglutaryl-CoA reductase inhibitor; risk assessment