Elderly adults with low CAC may not be at risk for CVD
Older adults with low coronary artery calcium scores were found to have significantly low CV risk, according to findings published in the Journal of the American College of Cardiology.
Elderly adults with low galectin-3 levels and no carotid plaque were also found to have low risk for CVD.
Martin Bødtker Mortensen, MD, PhD, and colleagues investigated risk markers that could identify elderly adults at low short-term risk for CHD and CVD.
“Given the broadened indication for statin therapy in recent guidelines combined with the dominant impact of age on estimated [atherosclerotic] CVD risk using traditional risk calculators, most elderly individuals will eventually be considered to be so high risk for ASCVD that everyone will qualify for lifelong preventive strain therapy,” Mortensen, of the department of cardiology at Aarhus University Hospital in Denmark, and colleagues wrote.
Determining negative risk marker performance
The researchers analyzed the data of participants in the BioImage Study (n = 5,805; mean age, 69 years; 44% men; median follow-up, 2.7 years).
Participants with CAC scores of 0 and 10 or less had the strongest negative risk markers in terms of mean diagnostic likelihood ratios for CHD (0.2 for both) and CVD (0.41 for CAC score of 0; 0.48 for CAC score 10), the researchers wrote.
Adults with galectin-3 levels of less than 25th percentile had the next strongest negative risk marker diagnostic likelihood ratios (0.44 for CHD; 0.43 for CVD), followed by absence of carotid plaque (0.39 for CHD; 0.65 for CVD).
Downward reclassification for the American College of Cardiology/American Heart Association class I statin eligibility threshold was most affected by CAC score of 10 or less (net reclassification index [NRI] = 0.28), CAC of 0 (NRI = 0.23), galectin-3 less than 25th percentile (NRI = 0.14) and absence of carotid plaque (NRI = 0.08), the researchers wrote.
“These novel data indicate that galactin-3 < 25th percentile may be a clinically useful negative risk marker for ASCVD de-risking,” Mortensen and colleagues wrote. “Our results hold the potential to markedly improve statin allocation in elderly individuals by deescalating or even withholding preventive therapy in elderly individuals at truly low ASCVD risk despite advancing age.”
Better ways to evaluate risk factors
In a related editorial, Michael J. Blaha, MD, MPH, director of clinical research and professor of medicine at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease and a Cardiology Today Next Gen Innovator, Ron Blankstein, MD, co-director of the Cardiovascular Imaging Training Program, associate physician of preventive cardiology and director of cardiac CT at Brigham and Women’s Hospital and associate professor of medicine and radiology at Harvard Medical School, and Khurram Nasir, MD, MPH, associate professor of internal medicine at the Yale School of Medicine’s Center for Outcomes Research and Evaluation, wrote: “The data from Mortensen et al remind us that other risk factors, like atherosclerosis imaging tests, have particular value as negative risk factors and may be key to limiting potential overuse of primary prevention pharmacotherapies in older adults.” – by Earl Holland Jr.
Disclosures: Blaha, Mortensen and Nasir report no relevant financial disclosures. Blankstein reports he receives research and grant support from Amgen and Astellas. Please see the study for all other authors’ relevant financial disclosures.