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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Community-Based Provision of Statin and Aspirin After the Detection of Coronary Artery Calcium Within a Community-Based Screening Cohort

Allen J. Taylor, MD^_*,,_*, Jody Bindeman, BSN^_*, Irwin Feuerstein, MD^_*,, Toan Le, ScD^_*, Kelly Bauer, BSN^_*, Carole Byrd, LVN^_*, Holly Wu, MD^_* and Patrick G. O’Malley, MD, MPH^_*,

^_* Departments of Medicine, Cardiology Service, Walter Reed Army Medical Center, Washington, DC
Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Manuscript received July 20, 2007; revised manuscript received November 14, 2007, accepted November 19, 2007.

^_* Reprint requests and correspondence: Dr. Allen J. Taylor, Chief, Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, Room 4A34, Washington, DC 20307-5001. (Email: allen.taylor{at}na.amedd.army.mil).

Objectives: We examined the association of coronary artery calcium (CAC) detected on a screening exam with subsequent statin and aspirin usage in a healthy male screening cohort.

Background: Whether the presence of CAC, an independent predictor of coronary heart disease outcomes, alters clinical management, such as the use of preventive medications, is unknown.

Methods: Men (n = 1,640) ages 40 to 50 years (mean 42 years) were screened for coronary heart disease risk factors and CAC. The CAC scores and risk factors were reported to patients, and results were made available in the electronic medical record; however, medications were not prescribed or recommended by the study. During up to 6 years of subsequent annual structured telephone follow-up, we observed the community-based initiation and persistence of aspirin and statin therapy.

Results: A progressive increase in the incidence of pharmacotherapy was noted over time such that those with CAC were 3 times more likely to receive a statin (48.5% vs. 15.5%, p < 0.001) and also significantly more likely to receive aspirin (53.0% vs. 32.3%; p < 0.001) than those without CAC. In multivariable models controlling for National Cholesterol Education Program risk variables and baseline medication use, CAC was strongly and independently associated with use of either statin (odds ratio [OR] 3.53; 95% confidence interval [CI] 2.66 to 4.69), aspirin (OR 3.05; 95% CI 2.30 to 4.05) or both (OR 6.97; 95% CI 4.81 to 10.10).

Conclusions: In this prospective cohort, the presence of coronary calcification was associated with an independent 3-fold greater likelihood of statin and aspirin usage.

Abbreviations and Acronyms   CAC = coronary artery calcium   LDL-C = low-density lipoprotein cholesterol   NCEP = National Cholesterol Education Program

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