Short and Long Term Prognosis after Coronary Artery Calcium Scoring

Similar documents
New Paradigms in Predicting CVD Risk

Imaging-Guided Statin Allocation: Seeing Is Believing

Coronary Artery Calcium. Vimal Ramjee, MD FACC The Chattanooga Heart Institute

Khurram Nasir, MD MPH

Preclinical Detection of CAD: Is it worth the effort? Michael H. Crawford, MD

Coronary Artery Calcium Scoring Mirvat Alasnag FACP, FRCP, FSCCT, FSCAI, FASE King Fahd Armed Forces Hospital, Jeddah. March 2017

Financial Disclosures. Coronary Artery Calcification. Objectives. Coronary Artery Calcium 6/6/2018. Heart Disease Statistics At-a-Glace 2017

Are We Ready for a Paradigm Shift From Risk Factors to Detection of Subclinical Coronary Atherosclerosis? Lessons From MESA. Khurram Nasir, MD MPH

The Multiethnic Study of Atherosclerosis (MESA) Cardiovascular Risk in Hispanics

Cardiac CT for Risk Assessment: Do we need to look beyond Coronary Artery Calcification

Subclinical atherosclerosis in CVD: Risk stratification & management Raul Santos, MD

10/8/2015. MN Nursing Conference October 7th, 2015 Michael Miedema, MD MPH. None

The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases

NEW GUIDELINES FOR CHOLESTEROL

Coronary Artery Calcium: Absence Makes the Heart Younger?

Are Lipids (or Risk Factors) the Optimal Marker for ASCVD Risk Assessment? Time for Paradigm Shift? Franklin D. Roosevelt. Khurram Nasir, MD MPH

The role of coronary artery calcium score on the detection of subclinical atherosclerosis in metabolic diseases

Sanger Heart & Vascular Institute Symposium 2015

Using Coronary Artery Calcium Score in the Quest for Cardiac Health. Robert J. Hage, D.O.

Combining Coronary Artery Calcium Scanning with SPECT/PET Myocardial Perfusion Imaging

2/20/2013. Why use imaging in CV prevention? Update on coronary CTA in 2013 Coronary CTA for 1 0 prevention: pros and cons Are we there yet?

Current and Future Imaging Trends in Risk Stratification for CAD

Supplementary Online Content

ACC/AHA GUIDELINES ON LIPIDS AND PCSK9 INHIBITORS

Prevention of Heart Disease: The New Guidelines

Diagnostic and Prognostic Value of Coronary Ca Score

Potential recommendations for CT coronary angiography in athletes

Calculating Risk for Primary Prevention of Cardiovascular Disease (CVD)

4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for

CVD risk assessment using risk scores in primary and secondary prevention

Best Lipid Treatments

Calcium scoring Clinical and prognostic value

Risk Stratification for CAD for the Primary Care Provider

Kavitha Yaddanapudi Stony brook University New York

Dr Chris Ellis. Consultant Cardiologist Auckland

No relevant financial relationships

Conceptual Approach to CAD Risk. Disclosures. Integrating Imaging and Biomarkers for Optimal CVD Risk Assessment and Management 2/10/2014.

LDL cholesterol (p = 0.40). However, higher levels of HDL cholesterol (> or =1.5 mmol/l [60 mg/dl]) were associated with less progression of CAC

Coronary Artery Calcification

Disclosures. Prevention of Heart Disease: The New Guidelines. Summary of Talk. Four guidelines. No relevant disclosures.

Cardiovascular Risk Assessment Using Risk Scores in Primary Prevention. Khurram Nasir, MD MPH

Treatment of Cardiovascular Risk Factors. Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center

Testing the Asymptomatic CAD Patient: When and Why?

Inflammation and and Heart Heart Disease in Women Inflammation and Heart Disease

No relevant financial relationships

Disclosure. No relevant financial relationships. Placebo-Controlled Statin Trials

JUPITER NEJM Poll. Panel Discussion: Literature that Should Have an Impact on our Practice: The JUPITER Study

The Art of Cardiovascular Risk Assessment

1. Which one of the following patients does not need to be screened for hyperlipidemia:

BENEFIT APPLICATION BLUECARD/NATIONAL ACCOUNT ISSUES

Lipid Management: The Next Level How Will the New ACC/AHA Guidelines Change My Practice

PCSK9 Inhibitors and Modulators

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam

Renal Artery Calcification and Mortality Among Clinically Asymptomatic Adults

Who Cares About the Past?

Welcome! To submit questions during the presentation: or Text:

Current Cholesterol Guidelines and Treatment of Residual Risk COPYRIGHT. J. Peter Oettgen, MD

2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary

Atherosclerotic Disease Risk Score

Dyslipidemia in the light of Current Guidelines - Do we change our Practice?

Coronary Artery Calcium Scanning Should be Used for Primary Prevention

Learning Objectives. Predicting and Preventing Cardiovascular Disease. ACC/AHA Cholesterol Guidelines Key differences vs ATP III

MOHAMMED R. ESSOP DIVISION OF CARDIOLOGY CH-BARAGWANATH HOSPITAL

David Ramenofsky, MD Bryan Kestenbaum, MD

Defining Severe Familial Hypercholesterolemia. Raul D. Santos MD, PhD Brazil

Supplement materials:

Risk Assessment for Primary Prevention

Corporate Medical Policy

Clinical Investigations

Vascular disease. Structural evaluation of vascular disease. Goo-Yeong Cho, MD, PhD Seoul National University Bundang Hospital

Disclosures CORONARY CALCIUM SCORING REVISITED. Learning Objectives. Scoring Methods. Consultant for M2S, Inc. Coronary Calcium Scoring: Software

Management of Lipid Disorders and Hypertension: Implications of the New Guidelines

How to Reduce Residual Risk in Primary Prevention

David Y. Gaitonde, MD, FACP Endocrinology DDEAMC, Fort Gordon

MPS and Calcium Score in asymptomatic patient F. Mut, J. Vitola

CARDIAC IMAGING FOR SUBCLINICAL CAD

MEDICAL POLICY SUBJECT: CORONARY CALCIUM SCORING

Carotid Ddisease, Carotid IMT and Risk of Stroke

CLINICAL STUDY. Yasser Khalil, MD; Bertrand Mukete, MD; Michael J. Durkin, MD; June Coccia, MS, RVT; Martin E. Matsumura, MD

Disclosure. No relevant financial relationships. Placebo-Controlled Statin Trials

CORONARY ARTERY CALCIUM AND INCIDENT STROKE IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA) COHORT ASHLEIGH A. OWEN, MD

Lipids What s new? Meera Jain, MD Providence Portland Medical Center

Physical Activity and Coronary calcification ADJ ASSOCIATE PROFESSOR TAN SWEE YAW NATIONAL HEART CENTRE SINGAPORE

Coronary artery calcium (CAC) testing may be useful for

Understanding new international guidelines to tackle CV Risk: A practical model John Deanfield, MD UCL, London United Kingdom s

MEDICAL POLICY. 02/15/18 CATEGORY: Technology Assessment

New Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.

Role of Nonenhanced Multidetector CT Coronary Artery Calcium Testing in Asymptomatic and Symptomatic Individuals 1

SUPPLEMENTAL MATERIAL

HIV and Cardiovascular Disease: Epidemiology, Mechanisms, and Clinical Implications

Clinical Investigations

Coronary Calcium Predicts Events Better With Absolute Calcium Scores Than Age-Sex-Race/Ethnicity Percentiles

Use of Coronary Artery Calcium Scoring for Risk Stratification

CONTRIBUTING FACTORS FOR STROKE:

Is computed tomography angiography really useful in. of coronary artery disease?

Kathryn M. Rexrode, MD, MPH. Assistant Professor. Division of Preventive Medicine Brigham and Women s s Hospital Harvard Medical School

Cardiovascular risk assessment in patients with diabetes

Diabetes and Occult Coronary Artery Disease

Summary HTA. HTA-Report Summary

4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS?

Transcription:

Short and Long Term Prognosis after Coronary Artery Calcium Scoring In Pre-Elderly and Elderly Patients Michael J. Blaha MD MPH Presented by: Michael J. Blaha July 24, 2017 1

Talk Outline 1. Coronary artery calcium (CAC), disease scores, and risk integration 2. CAC in pre-elderly patients 3. The MESA CHD Risk Score 4. CAC in elderly patients several caveats July 24, 2017 2

Coronary Artery Calcium and Risk Integration Part I July 24, 2017 3

~1 msv

Relationship of Calcification to Coronary Atherosclerosis 20% Rumberger, Circulation 1995 July 24, 2017 5

Continuum of Atherosclerosis Propagation Prior to a CHD Event Genetics Environment Funnel Risk Factors Biomarkers Subclinical Atherosclerosis Overt CAD

RISK Subclinical Disease Detection Model Integrates Risk Exposure!! 0 10 20 30 40 50 60 70 80 90 AGE

Coronary Artery Calcium in Pre-Elderly Patients Part II July 24, 2017 8

11

12

13

14

15

CAC and Age Biologic Age > Chronologic Age Tota-Maharaj, et al. Mayo Clinic Proceedings. 2014 16

17

CAC = 0

Comparing Negative Risk Markers in the Multi-Ethnic Study of Atherosclerosis A CAC score of zero is the strongest negative risk factor for the development of ASCVD. Imaging Hypothesis due to superior sensitivity, imaging tests for subclinical atherosclerosis are excellent at ruling out or downgrading risk estimates. Blaha MJ, et al. Circulation. 2016

Important Covariates Influencing Likelihood Ratio for CAC=0 0.2 0.4 0.6 0.8 1.0 0.2 0.4 0.6 0.8 1.0 0 0 Likelihood Ratio for Zero CAC 40 50 60 70 80 Age in years 0% 5% 10% 15% 20% 25% 30% Pre-Test Risk Estimate (10-year CHD Risk) Age MESA FRS July 24, 2017 20

Percent of U.S. Adults Who Would Be Eligible for Statin Therapy for Primary Prevention, According to Set of Guidelines and Age Group. Pencina MJ et al. N Engl J Med 2014. DOI: 10.1056/NEJMoa1315665

Nasir K et et al, JACC 2015

24

The MESA CHD Risk Score Part III July 24, 2017 25

MESA CHD Risk Score

The MESA CHD Risk Score

The MESA CHD Risk Score

The MESA CHD Risk Score

Please download the MESA Risk Score app! Search MESA CHD Risk in the app store Currently only available for Android Coming soon for iphone!

Coronary Artery Calcium in Pre-Elderly Patients Several Caveats! Part IV July 24, 2017 32

Challenges in Risk Stratification in the Elderly All-cause mortality stratified by age and CAC Those with 75 years old have highest rate of long term (>10 years) all-cause mortality regardless of CAC group 1 Nakanishi, et al. EHJ IMG, 2015.

Cause specific mortality by CAC group <75 Years (2,436 deaths) 75 Years (722 deaths) CVD CHD Cancer CVD CHD Cancer CAC=0 0.3 0.1 0.7 7.9 4.2 6.9 CAC 1-99 0.6 0.3 1.1 7.1 3.3 5.5 CAC 100-299 1.5 0.9 1.7 10.1 4.7 8.7 CAC 300 3.1 1.9 2.6 17.7 10.5 9.2

Cause specific mortality by CAC group <75 Years (2,436 deaths) 75 Years (722 deaths) CVD CHD Cancer CVD CHD Cancer CAC=0 0.3 0.1 0.7 7.9 4.2 6.9 CAC 1-99 0.6 0.3 1.1 7.1 3.3 5.5 CAC 100-299 1.5 0.9 1.7 10.1 4.7 8.7 CAC 300 3.1 1.9 2.6 17.7 10.5 9.2

Cause specific mortality by CAC group <75 Years (2,436 deaths) 75 Years (722 deaths) CVD CHD Cancer CVD CHD Cancer CAC=0 0.3 0.1 0.7 7.9 4.2 6.9 CAC 1-99 0.6 0.3 1.1 7.1 3.3 5.5 CAC 100-299 1.5 0.9 1.7 10.1 4.7 8.7 CAC 300 3.1 1.9 2.6 17.7 10.5 9.2

Cause specific mortality by CAC group <75 Years (2,436 deaths) 75 Years (722 deaths) CVD CHD Cancer CVD CHD Cancer CAC=0 0.3 0.1 0.7 7.9 4.2 6.9 CAC 1-99 0.6 0.3 1.1 7.1 3.3 5.5 CAC 100-299 1.5 0.9 1.7 10.1 4.7 8.7 CAC 300 3.1 1.9 2.6 17.7 10.5 9.2

Cause-specific mortality by CAC category 50% <75 Years 40% 30% 20% 10% 0% 50% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD 75 Years 40% 30% 20% 10% 0% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD

Cause-specific mortality by CAC category 50% <75 Years 40% 30% 20% 10% 0% 50% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD 75 Years 40% 30% 20% 10% 0% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD

Cause-specific mortality by CAC category 50% <75 Years 40% 30% 20% 10% 0% 50% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD 75 Years 40% 30% 20% 10% 0% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD

Cause-specific mortality by CAC category 50% <75 Years 40% 30% 20% 10% 0% 50% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD 75 Years 40% 30% 20% 10% 0% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD

Cause-specific mortality by CAC category 50% <75 Years 40% 30% 20% 10% 0% 50% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD 75 Years 40% 30% 20% 10% 0% CAC 0 CAC 1-99 CAC 100-299 CAC 300 Cancer CVD CHD Non-CHD CVD

Hazard of cause-specific mortality CAC=0 CAC 1-99 Model 2 2.14 <75 Years 75 years CVD CHD Cancer CVD CHD Cancer Reference Reference Reference Reference Reference Reference (1.67-2.75) CAC 100-299 Model 2 4.69 (3.60-6.13) CAC 300 Model 2 9.45 (7.45-11.99) 2.27 (1.55-3.34) 6.10 (4.13-9.01) 12.91 (9.07-18.37) 1.61 (1.36-1.91) 2.43 (1.98-2.99) 3.61 (2.99-4.35) 0.91 (0.51-1.62) 1.24 (0.71-2.17) 2.15 (1.29-3.59) 0.77 (0.35-1.72) 1.05 (0.48-2.30) 2.18 (1.08-4.37) Model 2 race, gender, hypertension, hyperlipidemia, smoking, diabetes, family history CHD 0.74 (0.40-1.39) 1.15 (0.63-2.10) 1.18 (0.67-2.06)

Hazard of cause-specific mortality CAC=0 CAC 1-99 Model 2 2.14 <75 Years 75 years CVD CHD Cancer CVD CHD Cancer Reference Reference Reference Reference Reference Reference (1.67-2.75) CAC 100-299 Model 2 4.69 (3.60-6.13) CAC 300 Model 2 9.45 (7.45-11.99) 2.27 (1.55-3.34) 6.10 (4.13-9.01) 12.91 (9.07-18.37) 1.61 (1.36-1.91) 2.43 (1.98-2.99) 3.61 (2.99-4.35) 0.91 (0.51-1.62) 1.24 (0.71-2.17) 2.15 (1.29-3.59) 0.77 (0.35-1.72) 1.05 (0.48-2.30) 2.18 (1.08-4.37) Model 2 race, gender, hypertension, hyperlipidemia, smoking, diabetes, family history CHD 0.74 (0.40-1.39) 1.15 (0.63-2.10) 1.18 (0.67-2.06)

Hazard of cause-specific mortality CAC=0 CAC 1-99 Model 2 2.14 <75 Years 75 years CVD CHD Cancer CVD CHD Cancer Reference Reference Reference Reference Reference Reference (1.67-2.75) CAC 100-299 Model 2 4.69 (3.60-6.13) CAC 300 Model 2 9.45 (7.45-11.99) 2.27 (1.55-3.34) 6.10 (4.13-9.01) 12.91 (9.07-18.37) 1.61 (1.36-1.91) 2.43 (1.98-2.99) 3.61 (2.99-4.35) 0.91 (0.51-1.62) 1.24 (0.71-2.17) 2.15 (1.29-3.59) 0.77 (0.35-1.72) 1.05 (0.48-2.30) 2.18 (1.08-4.37) Model 2 race, gender, hypertension, hyperlipidemia, smoking, diabetes, family history CHD 0.74 (0.40-1.39) 1.15 (0.63-2.10) 1.18 (0.67-2.06)

SUMMARY AND TAKE HOME: CAC for Older Patients When Individualization of Prevention Is Required!! 1. When Risk/Decision to Treat is Uncertain Family History, Borderline lipids, Metabolic Syndrome 2. Statin Reluctant Patient 3. Statin Intolerant Patient 4. MESA CHD Risk Score very helpful! 5. Limited use in those >75 years old right now July 24, 2017 47

THANK YOU!

July 24, 2017 49

2024 © healthdocbox.com Privacy Policy | Terms of Service | Feedback