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Subclinical Atherosclerosis, Statin Eligibility, and Outcomes in African American Individuals: The Jackson Heart Study.

Publication ,  Journal Article
Shah, RV; Spahillari, A; Mwasongwe, S; Carr, JJ; Terry, JG; Mentz, RJ; Addison, D; Hoffmann, U; Reis, J; Freedman, JE; Lima, JAC; Correa, A ...
Published in: JAMA Cardiol
June 1, 2017

IMPORTANCE: 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. OBJECTIVE: 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). DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMES AND MEASURES: Nonzero coronary artery calcium (CAC) score, abdominal aortic calcium score, and incident ASCVD (ie, myocardial infarction, ischemic stroke, or fatal coronary heart disease). RESULTS: 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). CONCLUSIONS AND RELEVANCE: 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.

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Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

June 1, 2017

Volume

2

Issue

6

Start / End Page

644 / 652

Location

United States

Related Subject Headings

  • Vascular Calcification
  • Tomography, X-Ray Computed
  • Risk Assessment
  • Prospective Studies
  • Practice Guidelines as Topic
  • Mississippi
  • Middle Aged
  • Male
  • Incidence
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
 

Citation

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Shah, R. V., Spahillari, A., Mwasongwe, S., Carr, J. J., Terry, J. G., Mentz, R. J., … Murthy, V. L. (2017). Subclinical Atherosclerosis, Statin Eligibility, and Outcomes in African American Individuals: The Jackson Heart Study. JAMA Cardiol, 2(6), 644–652. https://doi.org/10.1001/jamacardio.2017.0944
Shah, Ravi V., Aferdita Spahillari, Stanford Mwasongwe, J Jeffrey Carr, James G. Terry, Robert J. Mentz, Daniel Addison, et al. “Subclinical Atherosclerosis, Statin Eligibility, and Outcomes in African American Individuals: The Jackson Heart Study.JAMA Cardiol 2, no. 6 (June 1, 2017): 644–52. https://doi.org/10.1001/jamacardio.2017.0944.
Shah RV, Spahillari A, Mwasongwe S, Carr JJ, Terry JG, Mentz RJ, et al. Subclinical Atherosclerosis, Statin Eligibility, and Outcomes in African American Individuals: The Jackson Heart Study. JAMA Cardiol. 2017 Jun 1;2(6):644–52.
Shah, Ravi V., et al. “Subclinical Atherosclerosis, Statin Eligibility, and Outcomes in African American Individuals: The Jackson Heart Study.JAMA Cardiol, vol. 2, no. 6, June 2017, pp. 644–52. Pubmed, doi:10.1001/jamacardio.2017.0944.
Shah RV, Spahillari A, Mwasongwe S, Carr JJ, Terry JG, Mentz RJ, Addison D, Hoffmann U, Reis J, Freedman JE, Lima JAC, Correa A, Murthy VL. Subclinical Atherosclerosis, Statin Eligibility, and Outcomes in African American Individuals: The Jackson Heart Study. JAMA Cardiol. 2017 Jun 1;2(6):644–652.

Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

June 1, 2017

Volume

2

Issue

6

Start / End Page

644 / 652

Location

United States

Related Subject Headings

  • Vascular Calcification
  • Tomography, X-Ray Computed
  • Risk Assessment
  • Prospective Studies
  • Practice Guidelines as Topic
  • Mississippi
  • Middle Aged
  • Male
  • Incidence
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors