Abstract 13913: Predictive Ability of Positive Risk Enhancing Factors and Coronary Artery Calcium Scoring in the Multi-Ethnic Study of Atherosclerosis

IntroductionThe 2018 AHA/ACC Multisociety cholesterol guidelines recommend considering risk-enhancing factors (REFs) to facilitate decision for statin therapy in borderline and intermediate risk adults without diabetes mellitus (DM). The presence of REFs may favor statin therapy; after assessing REFs, guidelines suggest coronary artery calcium (CAC) scoring in those with uncertain risk.HypothesisWe hypothesized that the majority of patients would have multiple REFs, and that CAC would better predict hard atherosclerotic cardiovascular disease (ASCVD) outcomes than number of REFs.MethodsAmong 6,814 participants aged 45-75 years from the Multi-Ethnic Study of Atherosclerosis, we included those who had baseline estimated 10-year ASCVD risk of 5-/=100. The hard ASCVD event rate was 7.4 (CI 5.5-9.9) per 1,000 person-years with 0 REFs, 6.0 (4.8-7.5) with 1-2 REFs, 9.9 (7.6-13.2) with 3-4 REFs, and 12.9 (6.7-24.8) with 5+ REFs. Hard ASCVD event rates were 4.4 (3.4-5.8) in participants with CAC=0 and 13.6 (10.6-17.4) with CAC >/=100.ConclusionsIn borderline and intermediate risk primary prevention patients without DM evaluated for REFs, 24% would be stratified via AHA/ACC guidelines to low risk of future ASCVD events via REFs as compared to 49% via CAC assessment. Given that the presence of 1-2 REFs was not associated with a higher hard ASCVD rate, >/=3 REFs in combination may be more effective to influence risk-benefit discussion when considering initiation of statin therapy.