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Comparative Study
. 2016 Aug 19;5(8):e003410.
doi: 10.1161/JAHA.116.003410.

2013 ACC/AHA Cholesterol Guideline Versus 2004 NCEP ATP III Guideline in the Prediction of Coronary Artery Calcification Progression in a Korean Population

Yun Kyung Cho  1 , Chang Hee Jung  2 , Yu Mi Kang  1 , Jenie Yoonoo Hwang  3 , Eun Hee Kim  3 , Dong Hyun Yang  4 , Joon-Won Kang  4 , Joong-Yeol Park  1 , Hong-Kyu Kim  3 , Woo Je Lee  2
Affiliations
Comparative Study

2013 ACC/AHA Cholesterol Guideline Versus 2004 NCEP ATP III Guideline in the Prediction of Coronary Artery Calcification Progression in a Korean Population

Yun Kyung Cho et al. J Am Heart Assoc. .

Abstract

Background: Since the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, significant controversy has surrounded the applicability of the new cholesterol guidelines and the Pooled Cohort Equations. In this present study, we investigated whether eligibility for statin therapy determined by the 2013 ACC/AHA guidelines on the management of blood cholesterol is better aligned with the progression of coronary artery calcification (CAC) detected by coronary computed tomography angiography (CCTA) than the previously recommended 2004 National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines.

Methods and results: We enrolled 1246 asymptomatic participants who underwent repeated CAC score measurement during routine health examinations. The CAC score progression was defined as either incident CAC in a population free of CAC at baseline or increase ≥2.5 units between the baseline and final square root of CAC scores participants who had detectable CAC at baseline examination. Application of the ACC/AHA guidelines to the study population increased the proportion of statin-eligible subjects from 20.5% (according to ATP III) to 54.7%. Statin-eligible subjects, as defined by ACC/AHA guidelines, showed a higher odds ratio for CAC score progression than those considered statin eligible according to ATP III guidelines (2.73 [95% CI, 2.07-3.61] vs 2.00 [95% CI, 1.49-2.68]).

Conclusions: Compared with the ATP III guidelines, the new ACC/AHA guidelines result in better discrimination of subjects with cardiovascular risk detected by CAC score progression in an Asian population.

Keywords: Pooled Cohort Equation; atherosclerosis; cardiovascular disease; cholesterol guidelines; coronary artery calcification.

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Figures

Figure 1
Figure 1
A, Flow diagram of participants who would be eligible for statin therapy according to each set of guidelines and age group. B, Proportion of participants who would be eligible for statin therapy according to each set of guidelines and age group. Proportions were calculated within the total population (N=1289). *“Statin considered” indicates statin candidates who are nondiabetic individuals with 5% to <7.5% 10‐year ASCVD risk among 40 to 75 years of age with LDL‐C 1.8 to 4.9 mmol/L. ACC/AHA indicates American College of Cardiology/American Heart Association; ASCVD, atherosclerotic cardiovascular disease; ATP III, Adult Treatment Panel III; LDL‐C, low‐density lipoprotein cholesterol.
Figure 2
Figure 2
Comparison of the proportion of nonprogressor and progressor in statin‐eligible population according to each set of guideline. Proportions were calculated within the total population (N=1289). ACC/AHA indicates American College of Cardiology/American Heart Association; ATP III, Adult Treatment Panel III; Not Rec, not recommended for statin; Rec, Recommended for statin.
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