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 )

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. Hypothesis 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 .