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1Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
3Division of Cardiology, Kaiser Permanente Northern California, Oakland, CA, USA.
4Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
5Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
6Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
Copyright © 2017 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
(1) Statin candidates averse to treatment: patients who are advised, by guidelines, to be on statin therapy (atherosclerotic cardiovascular disease [ASCVD] risk score >5% per the pooled cohort equation recommended by the American College of Cardiology/American Heart Association [ACC/AHA]) but who prefer to avoid such therapy.
(2) Statin intolerant patients: several studies have suggested that many individuals who previously were deemed as statin intolerant may be able to tolerate statins when re-challenged. While many such individuals prefer not to be on statins, the identification of coronary plaque may serve as a signal to reconsider a statin, recognizing the greater benefits of such therapies in patients who have higher risk.
(3) Patients with premature family history of CHD: such individuals may benefit from more personalized risk assessment since most traditional risk equations do not include family history of premature CHD. Importantly, even when a strong family history is present, the actual burden of CAC—and thus a person's risk—may be highly variable [12].
CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.
CAC=0 | CAC >0 |
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Lifestyle changes | Lifestyle changes |
Guideline directed care of all modifiable risk factors | Guideline directed care of all modifiable risk factors |
Statin therapy may be deferred if patient preference to avoid, and 10-year risk of ASCVD is <20% | Moderate to severe intensity statin therapy, especially if CAC ≥100 Consider aspirin therapy if CAC ≥ 100 |
How does coronary artery calcium testing improve outcomes? | |
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√ | Improvement in risk factor profile |
√ | Intensification of preventive therapies |
√ | Better adherence to preventive therapies |
√ | Dietary modifications |
√ | Increased exercise |
CAC, coronary artery calcium; ASCVD, atherosclerotic cardiovascular disease.