Coronary artery disease detected by coronary computed tomographic angiography is associated with intensification of preventive medical therapy and lower low-density lipoprotein cholesterol

Edward Hulten; Marcio Sommer Bittencourt; Avinainder Singh; Daniel O'Leary; Mitalee P Christman; Wafa Osmani; Suhny Abbara; Michael L Steigner; Quynh A Truong; Khurram Nasir; Frank F Rybicki; Josh Klein; Jon Hainer; Thomas J Brady; Udo Hoffmann; Brian B Ghoshhajra; Rory Hachamovitch; Marcelo F Di Carli; Ron Blankstein

doi:10.1161/CIRCIMAGING.113.001564

Coronary artery disease detected by coronary computed tomographic angiography is associated with intensification of preventive medical therapy and lower low-density lipoprotein cholesterol

Circ Cardiovasc Imaging. 2014 Jul;7(4):629-38. doi: 10.1161/CIRCIMAGING.113.001564. Epub 2014 Jun 6.

Authors

Edward Hulten¹, Marcio Sommer Bittencourt¹, Avinainder Singh¹, Daniel O'Leary¹, Mitalee P Christman¹, Wafa Osmani¹, Suhny Abbara¹, Michael L Steigner¹, Quynh A Truong¹, Khurram Nasir¹, Frank F Rybicki¹, Josh Klein¹, Jon Hainer¹, Thomas J Brady¹, Udo Hoffmann¹, Brian B Ghoshhajra¹, Rory Hachamovitch¹, Marcelo F Di Carli¹, Ron Blankstein²

Affiliations

¹ From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.).
² From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.). rblankstein@partners.org.

PMID: 24906356
DOI: 10.1161/CIRCIMAGING.113.001564

Abstract

Background: Coronary computed tomographic angiography (CCTA) is an accurate test for the identification of coronary artery disease (CAD), yet the impact of CCTA results on subsequent medical therapy and risk factors has not been widely reported.

Methods and results: We identified consecutive patients aged >18 years without prior CAD who underwent CCTA from 2004 to 2011 and had complete data on medications before and after CCTA. CCTA results were categorized as no CAD, <50% stenosis, and ≥50% stenosis. Based on the number of involved segments, extent of disease was categorized as nonextensive (≤4 segments) or extensive CAD (>4 segments). Electronic medical records and patient interviews were reviewed blinded to CCTA findings to assess initiation of aspirin and intensification of lipid-lowering therapies. Survival analysis was performed to evaluate intensification of lipid therapy as a predictor of cardiovascular death or nonfatal myocardial infarction. Among 2839 patients with mean follow-up of 3.6 years, the odds of physician intensification of lipid-lowering therapy significantly increased for those with nonobstructive CAD (odds ratio, 3.6; 95% confidence interval, 2.9-4.9; P<0.001) and obstructive CAD (odds ratio, 5.6; 95% confidence interval, 4.3-7.3; P<0.001). Low-density lipoprotein cholesterol levels declined significantly in association with intensification of lipid-lowering therapy after CCTA in all patient subgroups. In a hypothesis-generating analysis, among patients with nonobstructive but extensive CAD, statin use after CCTA was associated with a reduction in cardiovascular death or myocardial infarction (hazards ratio, 0.18; 95% confidence interval, 0.05-0.66; P=0.01).

Conclusions: Abnormal CCTA findings are associated with downstream intensification in statin and aspirin therapy. In particular, CCTA may lead to increased use of prognostically beneficial therapies in patients identified as having extensive, nonobstructive CAD.

Keywords: aspirin; prevention and control; prognosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aspirin / therapeutic use*
Cholesterol, LDL / blood*
Coronary Angiography / methods*
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / epidemiology
Coronary Artery Disease / prevention & control
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Incidence
Male
Massachusetts / epidemiology
Middle Aged
Multidetector Computed Tomography*
Odds Ratio
Platelet Aggregation Inhibitors / therapeutic use
Prognosis
Registries
Retrospective Studies
Risk Assessment / methods*
Risk Factors
Severity of Illness Index

Substances

Cholesterol, LDL
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Platelet Aggregation Inhibitors
Aspirin