Abstract 10377: Coronary Artery Calcium Testing to Guide Statin Allocation According to ASCVD Risk-enhancing Factors: Results From The Multi-ethnic Study of Atherosclerosis (MESA)

IntroductionThe 2018 AHA/ACC Multi-Society Cholesterol Guideline suggests risk-enhancing factors (REF) and coronary artery calcium (CAC) scoring for further risk stratification of atherosclerotic cardiovascular disease (ASCVD) among intermediate-risk individuals by the Pooled Cohorts Equations (PCE) to guide preventive efforts. REF are associated with higher ASCVD risk and may justify statin use. However, it is unknown whether the association of REF and incident ASCVD differs according to the presence of CAC.HypothesisREF are associated with incident ASCVD among intermediate-risk individuals with CAC.MethodsMESA is a prospective cohort study of 6814 participants free of known cardiovascular disease. We included participants at intermediate ASCVD risk (PCE ≥7.5% - 0).ResultsAmong 1383 participants, mean age was 64 (SD 7) years, 59% were male, 37% White, 11% Chinese, 33% Black, 19% Hispanic, and 45% had CAC=0. The prevalence of CAC=0 was 43% among those with ≥ 3 REF (Table). Over a median follow-up of 12 (IQR 11.5-12.6) years, 124 ASCVD events occurred. There was no significant association between individual REF or cumulative burden of REF and ASCVD in either CAC group, respectively.ConclusionAmong intermediate-risk individuals with a high REF burden, the prevalence of CAC=0 is 43%. No association between REF and incident ASCVD was found, likely due to the very low 10-year ASCVD risk CAC=0 portends and the narrowed range of risk among those at intermediate risk.