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Implications of Coronary Artery Calcium Testing for Treatment Decisions Among Statin Candidates According to the ACC/AHA Cholesterol Management Guidelines
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This review evaluates the cost-effectiveness of using coronary artery calcium (CAC) to guide long-term statin therapy compared with treating all patients eligible for statins according to 2013 American College of Cardiology/American Heart Association cholesterol management guidelines for atherosclerotic cardiovascular disease. The authors used a microsimulation model to compare costs and effectiveness from a societal perspective over a lifetime horizon. Both strategies resulted in similar costs and quality-adjusted life years (QALYs). CAC resulted in increased costs (+$81) and near-equal QALY (+0.01) for an incremental cost-effectiveness ratio of $8,100/QALY compared with the treat-all strategy. For 10,000 patients, the treat-all strategy would theoretically avert 21 atherosclerotic cardiovascular disease events, but would add 47,294 person-years of statins. With CAC costs <$100, and higher cost and/or disutility associated with statin therapy, CAC strategy was favored. These findings suggest the economic value of both approaches were similar. Clinicians should account for individual preferences in context of shared decision making when choosing the most appropriate strategy to guide statin decisions.
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“Compared with a strategy of treating all patients, the use of CAC score to guide long-term statin therapy has been shown to be cost-effective [27].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [27]
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Self-citationCoronary calcium is all we need for risk assessment, yet we do not use it often enough
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“29 The single RCT comparing a CAC-based with a risk factor-based strategy consistently showed improved cardiovascular risk factor control without increased downstream resource use by more appropriate resource allocation to at risk patients.”
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Primary Prevention for Intermediate Risk
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REMOVED: Correlation between COVID-19 and cardiac calcification
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RetractedPrognostic Value of Coronary Artery Calcium
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Self-citationThe not so secret power of cardiac CT: Prevention and value
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Coronary Artery Calcium Scanning: Indications and Patient Management
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Self-citation
Metadata
- Authors
- Hong, J. C., Blankstein, R., Shaw, L. J., Padula, W. V., Arrieta, A., Fialkow, J. A., Blumenthal, R. S., Blaha, M. J., Krumholz, H. M., & Nasir, K.
- Affiliations
- Johns Hopkins University (US)
- Brigham and Women's Hospital (US)
- Emory University (US)
- Florida International University (US)
- Baptist Hospital of Miami (US)
- Yale New Haven Hospital (US)
- Corresponding author
- Nasir, Khurram
- ORCID
- Venue
- JACC: Cardiovascular Imaging
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 10
- Issue
- 8
- Pages
- 938-952
- ISSN
- 1876-7591 (ISSN-L)
- 1936-878X
- OpenAlex
- W2744830475
- Cited by
- 101
- References
- 58
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 7 · 2023: 8 · 2022: 9 · 2021: 25 · 2020: 13 · 2019: 13 · 2018: 11 · 2017: 2
- FWCI
- 2.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Cardiovascular imaging (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johns Hopkins University
- Regeneron Pharmaceuticals
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- coronary artery calcium, statin therapy, cost-effectiveness, atherosclerotic cardiovascular disease, quality-adjusted life years, microsimulation model, shared decision-making, cardiovascular risk stratification
- MeSH terms
- Clinical Decision-Making, Aged, Aged, 80 and over, American Heart Association, Bayes Theorem, Computer Simulation, Coronary Artery Disease, Coronary Vessels, Cost-Benefit Analysis, Decision Support Techniques, Female, Humans, Male, Middle Aged, Monte Carlo Method, Predictive Value of Tests, Quality of Life, Time Factors, United States, Multivariate Analysis, Drug Costs, Treatment Outcome, Coronary Angiography, Practice Guidelines as Topic, Models, Economic, Quality-Adjusted Life Years, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Guideline Adherence, Vascular Calcification
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