Author + information
- Received January 14, 2020
- Revision received March 9, 2020
- Accepted March 23, 2020
- Published online September 7, 2020.
- Martin Bødtker Mortensen, MD, PhDa,∗ (, )
- Flemming Hald Steffensen, MD, PhDb,
- Hans Erik Bøtker, MD, DMSca,
- Jesper Møller Jensen, MD, PhDa,
- Niels Peter Rønnow Sand, MD, PhDc,
- Kristian Hay Kragholm, MD, PhDd,
- Helle Kanstrup, MD, PhDa,
- Henrik Toft Sørensen, MD, DMSce,
- Jonathon Leipsic, MDf,
- Michael J. Blaha, MD, MPHg and
- Bjarne Linde Nørgaard, MD, PhDa
- aDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- bDepartment of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark
- cDepartment of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- dDepartment of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- eDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- fSt. Pauls Hospital, UBC, Vancouver, British Columbia, Canada
- gJohns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Martin Bødtker Mortensen, Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark.
Objectives This study aimed to assess if information on CAD severity from coronary computed tomography angiography (CTA) can identify patients that benefit most from treating low-density lipoprotein-cholesterol (LDL-C) to American Heart Association/American College of Cardiology (ACC/AHA) and European Society of Cardiology (ESC) guidelines targets.
Background Current treatment guidelines for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) disregard severity of coronary artery disease (CAD) for treatment choices. It is unclear whether severity of CAD should be considered in treatment recommendations.
Methods Among 20,241 symptomatic patients undergoing diagnostic CTA from the Western Denmark Heart Registry, we assessed the number needed to treat (NNT) in 6 years to prevent 1 ASCVD event as well as the proportion of all events that could be prevented by treating LDL-C to targets. We assumed a 22% relative reduction of ASCVD events per 1 mmol/l reduction in LDL-C.
Results In multivariable analysis with no CAD as the reference, the subdistribution hazard ratio for ASCVD events was 4.0 (95% confidence interval [CI]: 3.3 to 4.9) for 1-vessel disease, 4.6 (3.5 to 6.0) for 2-vessel disease, and 5.6 (4.0 to 8.0) for 3-vessel disease. Consequently, the NNT to prevent 1 ASCVD event in 6 years by treating LDL-C to targets varied greatly from 233 (ESC) and 110 (ACC/AHA) for patients with no CAD to 8-9 for patients with 3-vessel disease (both ACC/AHA and ESC). The estimated percentage of ASCVD events that could be prevented by achieving guideline targets was 30% to 36% for patients with obstructive disease. However, <20% of patients achieved targets.
Conclusions An individualized approach based on CAD severity can identify symptomatic patients that are likely to derive most and least benefit from treating LDL-C to ACC/AHA and ESC treatment targets.
This study was funded by Aarhus University Hospital. The funding source had no role in design, conduct, analysis, or reporting of this study. Dr. Blaha has received grants from the National Institutes of Health, U.S. Food and Drug Administration, American Heart Association, and Aetna Foundation; grants and personal fees from Amgen; and personal fees from Sanofi, Regeneron, Novartis, Bayer, and Novo Nordisk outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received January 14, 2020.
- Revision received March 9, 2020.
- Accepted March 23, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.