Associations between C-reactive protein, coronary artery calcium, and cardiovascular events

Implications for the JUPITER population from MESA, a population-based cohort study

Michael J. Blaha, Matthew J. Budoff, Andrew P. Defilippis, Ron Blankstein, Juan J. Rivera, Arthur Agatston, Daniel H. O'Leary, Joao Lima, Roger S. Blumenthal, Khurram Nasir

Research output: Contribution to journalArticle

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Abstract

Background The JUPITER trial showed that some patients with LDL-cholesterol concentrations less than 3·37 mmol/L (<130 mg/dL) and high-sensitivity C-reactive protein (hsCRP) concentrations of 2 mg/L or more benefit from treatment with rosuvastatin, although absolute rates of cardiovascular events were low. In a population eligible for JUPITER, we established whether coronary artery calcium (CAC) might further stratify risk; additionally we compared hsCRP with CAC for risk prediction across the range of low and high hsCRP values. Method 950 participants from the Multi-Ethnic Study of Atheroslcerosis (MESA) met all criteria for JUPITER entry. We compared coronary heart disease and cardiovascular disease event rates and multivariable-adjusted hazard ratios after stratifying by burden of CAC (scores of 0, 1-100, or >100). We calculated 5-year number needed to treat (NNT) by applying the benefit recorded in JUPITER to the event rates within each CAC strata. Findings Median follow-up was 5·8 years (IQR 5·7- 5·9). 444 (47) patients in the MESA JUPITER population had CAC scores of 0 and, in this group, rates of coronary heart disease events were 0·8 per 1000 person-years. 74 of all coronary events were in the 239 (25) of participants with CAC scores of more than 100 (20·2 per 1000 person-years). For coronary heart disease, the predicted 5-year NNT was 549 for CAC score 0, 94 for scores 1-100, and 24 for scores greater than 100. For cardiovascular disease, the NNT was 124, 54, and 19. In the total study population, presence of CAC was associated with a hazard ratio of 4·29 (95 CI 1·99-9·25) for coronary heart disease, and of 2·57 (1·48-4·48) for cardiovascular disease. hsCRP was not associated with either disease after multivariable adjustment. Interpretation CAC seems to further stratify risk in patients eligible for JUPITER, and could be used to target subgroups of patients who are expected to derive the most, and the least, absolute benefit from statin treatment. Focusing of treatment on the subset of individuals with measurable atherosclerosis could allow for more appropriate allocation of resources. Funding National Institutes of Health-National Heart, Lung, and Blood Institute.

Original languageEnglish
Pages (from-to)684-692
Number of pages9
JournalThe Lancet
Volume378
Issue number9792
DOIs
StatePublished - Aug 20 2011
Externally publishedYes

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Numbers Needed To Treat
C-Reactive Protein
Coronary Vessels
Cohort Studies
Calcium
Coronary Disease
Population
Cardiovascular Diseases
National Heart, Lung, and Blood Institute (U.S.)
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Resource Allocation
National Institutes of Health (U.S.)
LDL Cholesterol
Atherosclerosis
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

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Associations between C-reactive protein, coronary artery calcium, and cardiovascular events : Implications for the JUPITER population from MESA, a population-based cohort study. / Blaha, Michael J.; Budoff, Matthew J.; Defilippis, Andrew P.; Blankstein, Ron; Rivera, Juan J.; Agatston, Arthur; O'Leary, Daniel H.; Lima, Joao; Blumenthal, Roger S.; Nasir, Khurram.

In: The Lancet, Vol. 378, No. 9792, 20.08.2011, p. 684-692.

Research output: Contribution to journalArticle

Blaha, MJ, Budoff, MJ, Defilippis, AP, Blankstein, R, Rivera, JJ, Agatston, A, O'Leary, DH, Lima, J, Blumenthal, RS & Nasir, K 2011, 'Associations between C-reactive protein, coronary artery calcium, and cardiovascular events: Implications for the JUPITER population from MESA, a population-based cohort study', The Lancet, vol. 378, no. 9792, pp. 684-692. https://doi.org/10.1016/S0140-6736(11)60784-8
Blaha, Michael J. ; Budoff, Matthew J. ; Defilippis, Andrew P. ; Blankstein, Ron ; Rivera, Juan J. ; Agatston, Arthur ; O'Leary, Daniel H. ; Lima, Joao ; Blumenthal, Roger S. ; Nasir, Khurram. / Associations between C-reactive protein, coronary artery calcium, and cardiovascular events : Implications for the JUPITER population from MESA, a population-based cohort study. In: The Lancet. 2011 ; Vol. 378, No. 9792. pp. 684-692.
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abstract = "Background The JUPITER trial showed that some patients with LDL-cholesterol concentrations less than 3·37 mmol/L (<130 mg/dL) and high-sensitivity C-reactive protein (hsCRP) concentrations of 2 mg/L or more benefit from treatment with rosuvastatin, although absolute rates of cardiovascular events were low. In a population eligible for JUPITER, we established whether coronary artery calcium (CAC) might further stratify risk; additionally we compared hsCRP with CAC for risk prediction across the range of low and high hsCRP values. Method 950 participants from the Multi-Ethnic Study of Atheroslcerosis (MESA) met all criteria for JUPITER entry. We compared coronary heart disease and cardiovascular disease event rates and multivariable-adjusted hazard ratios after stratifying by burden of CAC (scores of 0, 1-100, or >100). We calculated 5-year number needed to treat (NNT) by applying the benefit recorded in JUPITER to the event rates within each CAC strata. Findings Median follow-up was 5·8 years (IQR 5·7- 5·9). 444 (47) patients in the MESA JUPITER population had CAC scores of 0 and, in this group, rates of coronary heart disease events were 0·8 per 1000 person-years. 74 of all coronary events were in the 239 (25) of participants with CAC scores of more than 100 (20·2 per 1000 person-years). For coronary heart disease, the predicted 5-year NNT was 549 for CAC score 0, 94 for scores 1-100, and 24 for scores greater than 100. For cardiovascular disease, the NNT was 124, 54, and 19. In the total study population, presence of CAC was associated with a hazard ratio of 4·29 (95 CI 1·99-9·25) for coronary heart disease, and of 2·57 (1·48-4·48) for cardiovascular disease. hsCRP was not associated with either disease after multivariable adjustment. Interpretation CAC seems to further stratify risk in patients eligible for JUPITER, and could be used to target subgroups of patients who are expected to derive the most, and the least, absolute benefit from statin treatment. Focusing of treatment on the subset of individuals with measurable atherosclerosis could allow for more appropriate allocation of resources. Funding National Institutes of Health-National Heart, Lung, and Blood Institute.",
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T2 - Implications for the JUPITER population from MESA, a population-based cohort study

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AU - Budoff, Matthew J.

AU - Defilippis, Andrew P.

AU - Blankstein, Ron

AU - Rivera, Juan J.

AU - Agatston, Arthur

AU - O'Leary, Daniel H.

AU - Lima, Joao

AU - Blumenthal, Roger S.

AU - Nasir, Khurram

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N2 - Background The JUPITER trial showed that some patients with LDL-cholesterol concentrations less than 3·37 mmol/L (<130 mg/dL) and high-sensitivity C-reactive protein (hsCRP) concentrations of 2 mg/L or more benefit from treatment with rosuvastatin, although absolute rates of cardiovascular events were low. In a population eligible for JUPITER, we established whether coronary artery calcium (CAC) might further stratify risk; additionally we compared hsCRP with CAC for risk prediction across the range of low and high hsCRP values. Method 950 participants from the Multi-Ethnic Study of Atheroslcerosis (MESA) met all criteria for JUPITER entry. We compared coronary heart disease and cardiovascular disease event rates and multivariable-adjusted hazard ratios after stratifying by burden of CAC (scores of 0, 1-100, or >100). We calculated 5-year number needed to treat (NNT) by applying the benefit recorded in JUPITER to the event rates within each CAC strata. Findings Median follow-up was 5·8 years (IQR 5·7- 5·9). 444 (47) patients in the MESA JUPITER population had CAC scores of 0 and, in this group, rates of coronary heart disease events were 0·8 per 1000 person-years. 74 of all coronary events were in the 239 (25) of participants with CAC scores of more than 100 (20·2 per 1000 person-years). For coronary heart disease, the predicted 5-year NNT was 549 for CAC score 0, 94 for scores 1-100, and 24 for scores greater than 100. For cardiovascular disease, the NNT was 124, 54, and 19. In the total study population, presence of CAC was associated with a hazard ratio of 4·29 (95 CI 1·99-9·25) for coronary heart disease, and of 2·57 (1·48-4·48) for cardiovascular disease. hsCRP was not associated with either disease after multivariable adjustment. Interpretation CAC seems to further stratify risk in patients eligible for JUPITER, and could be used to target subgroups of patients who are expected to derive the most, and the least, absolute benefit from statin treatment. Focusing of treatment on the subset of individuals with measurable atherosclerosis could allow for more appropriate allocation of resources. Funding National Institutes of Health-National Heart, Lung, and Blood Institute.

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