Subclinical Atherosclerosis, Statin Eligibility, and Outcomes in African American Individuals: The Jackson Heart Study.
Modern prevention guidelines substantially increase the number of individuals who are eligible for treatment with statins. Efforts to refine statin eligibility via coronary calcification have been studied in white populations but not, to our knowledge, in large African American populations.



To compare the relative accuracy of US Preventive Services Task Force (USPSTF) and American College of Cardiology/American Heart Association (ACC/AHA) recommendations in identifying African American individuals with subclinical and clinical atherosclerotic cardiovascular disease (ASCVD).



In this prospective, community-based study, 2812 African American individuals aged 40 to 75 years without prevalent ASCVD underwent assessment of ASCVD risk. Of these, 1743 participants completed computed tomography.



Nonzero coronary artery calcium (CAC) score, abdominal aortic calcium score, and incident ASCVD (ie, myocardial infarction, ischemic stroke, or fatal coronary heart disease).



Of the 2812 included participants, the mean (SD) age at baseline was 55.4 (9.4) years, and 1837 (65.3%) were female. The USPSTF guidelines captured 404 of 732 African American individuals (55.2%) with a CAC score greater than 0; the ACC/AHA guidelines identified 507 individuals (69.3%) (risk difference, 14.1%; 95% CI, 11.2-17.0; P < .001). Statin recommendation under both guidelines was associated with a CAC score greater than 0 (odds ratio, 5.1; 95% CI, 4.1-6.3; P < .001). While individuals indicated for statins under both guidelines experienced 9.6 cardiovascular events per 1000 patient-years, those indicated under only ACC/AHA guidelines were at low to intermediate risk (4.1 events per 1000 patient-years). Among individuals who were statin eligible by ACC/AHA guidelines, the 10-year ASCVD incidence per 1000 person-years was 8.1 (95% CI, 5.9-11.1) in the presence of CAC and 3.1 (95% CI, 1.6-5.9) without CAC (P = .02). While statin-eligible individuals by USPSTF guidelines did not have a significantly higher 10-year ASCVD event rate in the presence of CAC, African American individuals not eligible for statins by USPSTF guidelines had a higher ASCVD event rate in the presence of CAC (2.8 per 1000 person-years; 95% CI, 1.5-5.4) relative to without CAC (0.8 per 1000 person-years; 95%, CI 0.3-1.7) (P = .03).



The USPSTF guidelines focus treatment recommendations on 38% of high-risk African American individuals at the expense of not recommending treatment in nearly 25% of African American individuals eligible for statins by ACC/AHA guidelines with vascular calcification and at low to intermediate ASCVD risk.
Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
Ravi V
RV
Shah
Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard School of Public Health, Boston, Massachusetts3Department of Cardiology, Tufts Medical Center, Boston, Massachusetts.
Aferdita
A
Spahillari
Field Center, Jackson Heart Study, Jackson State University, Jackson, Mississippi.
Stanford
S
Mwasongwe
Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
J Jeffrey
JJ
Carr
Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
James G
JG
Terry
Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
Robert J
RJ
Mentz
Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging, Massachusetts General Hospital, Harvard Medical School, Boston.
Daniel
D
Addison
Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging, Massachusetts General Hospital, Harvard Medical School, Boston.
Udo
U
Hoffmann
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Jared
J
Reis
Department of Medicine, University of Massachusetts Medical School, Worcester.
Jane E
JE
Freedman
Department of Cardiology, Johns Hopkins University, Baltimore, Maryland.
Joao A C
JAC
Lima
Department of Medicine, University of Mississippi Medical Center, Jackson.
Adolfo
A
Correa
Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor.
Venkatesh L
VL
Murthy
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D050197:Atherosclerosis / Q000453:epidemiology* / Q000517:prevention & control; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors