期刊
JACC-CARDIOVASCULAR IMAGING
卷 15, 期 4, 页码 641-651出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcmg.2021.10.017
关键词
cardiovascular disease; coronary artery calcium; hypertriglyceridemia; icosapent ethyl; prevention; primary prevention; risk
资金
- National Heart, Lung, and Blood Institute (NHLBI) [HHSN268201500003I, N01-HC95159, N01-HC-95169]
- National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH) [UL1-TR-000040, UL1-TR001079, UL1-TR-001420, UL1-TR-001881]
- National Heart, Lung, and Blood Institute [HHSN268201800003I, HHSN268201800004I, HHSN268201800005I, HHSN268201800006I, HHSN268201800007I]
- NCATS [UL1TR001105]
- German Research Council [EI 969/2-3, ER 155/6-1, ER 155/6-2, HO 3314/2-1, HO 3314/2-2, HO 3314/2-3, HO 3314/4-3, INST 58219/32-1, JO 170/8-1, KN 885/3-1, PE 2309/2-1, SI 236/8-1, SI 236/9-1, SI 236/10-1]
- German Ministry of Education and Science [01EG0401, 01GI0856, 01GI0860, 01GS0820_WB2-C, 01ER1001D, 01GI0205]
- Ministry of Innovation, Science, Research and Technology, North Rhine-Westphalia
- Else KronerFresenius-Stiftung [2015_A119]
- German Social Accident Insurance (DGUV project) [FF-FP295]
- Competence Network for HIV/AIDS
- deanship of the University Hospital of the University Duisburg-Essen
- IFORES of the University Duisburg-Essen
- European Union
- German Competence Network Heart Failure
- Kulturstiftung Essen
- Protein Research Unit Within Europe
- Dr Werner-Jackstadt Stiftung
- Celgene Munchen
- Imatron/GE-Imatron
- Janssen
- Merck KG
- Philips
- ResMed Foundation
- Roche Diagnostics
- Sarstedt Co
- Siemens HealthCare Diagnostics
- Volkswagen Foundation
- Amarin Pharmaceuticals
- National Institutes of Health (NIH) [5T32HL007227]
- American Heart Association (AHA)
- National Aeronautics and Space Administration
- Novo Nordisk
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Amgen
- Novartis
- NIH
- Food and Drug Administration
- AHA
- Amgen Foundation
- GE Healthcare
- Bayer
- EMS
- Boston Scientific
- Jerold B. Katz Academy of Translational Research
This study evaluates whether the coronary artery calcium (CAC) score can enhance risk stratification for individuals with hypertriglyceridemia and the applicability of Icosapent ethyl (IPE) eligibility criteria.
OBJECTIVES In this study, we sought to evaluate whether the coronary artery calcium (CAC) score can enhance current paradigms for risk stratification among individuals with hypertriglyceridemia in primary prevention. The eligibility criteria for icosapent ethyl (IPE) were used as case example. BACKGROUND Recent trials of atherosclerotic cardiovascular disease (ASCVD) risk-reduction therapies for individuals with hypertriglyceridemia without clinical ASCVD restricted enrollment to participants with diabetes or various other risk factors. These criteria were mirrored in the Food and Drug Administration product label for IPE. METHODS We pooled 2,345 participants with triglycerides 150 to <500 mg/dL (or >178-<500 mg/dL if not on a statin) and without clinical ASCVD from MESA, CARDIA, the Dallas Heart Study, and the Heinz Nixdorf Recall study. We evaluated the incidence of ASCVD events overall, by IPE eligibility (as defined in the product label), and further stratified by CAC scores (0, >0-100, >100). The number needed to treat for 5 years (NNT5) to prevent 1 event was estimated among IPE-eligible participants, assuming a 21.8% relative risk reduction with IPE. In exploratory analyses, the NNT5 was also estimated among noneligible participants. RESULTS There was marked heterogeneity in CAC burden overall (45% CAC 0; 24% CAC >100) and across IPE eligibility strata. Overall, 17% of participants were eligible for IPE and 11.9% had ASCVD events within 5 years. Among participants eligible for IPE, 38% had CAC >100, and their event rates were markedly higher (15.9% vs 7.2%) and the NNT5 2.2-fold lower (29 vs 64) than those of the 25% eligible participants with CAC 0. Among the 83% participants not eligible for IPE, 20% had CAC >100, and their 5-year incidence of ASCVD (13.9%) was higher than the overall incidence among IPE-eligible participants. CONCLUSIONS CAC can improve current risk stratification and therapy allocation paradigms among individuals with hypertriglyceridemia without clinical ASCVD. Future trials of risk-reduction therapies in hypertriglyceridemia could use CAC >100 to enroll a high-risk study sample, with implications for a larger target population. (C) 2022 by the American College of Cardiology Foundation.
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