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Meta-Analysis
. 2017 Aug;10(8):833-842.
doi: 10.1016/j.jcmg.2017.01.030.

The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies: A Systematic Review and Meta-Analysis

Ankur Gupta  1 , Emily Lau  1 , Ravi Varshney  1 , Edward A Hulten  2 , Michael Cheezum  3 , Marcio S Bittencourt  4 , Michael J Blaha  5 , Nathan D Wong  6 , Roger S Blumenthal  5 , Matthew J Budoff  7 , Craig A Umscheid  8 , Khurram Nasir  9 , Ron Blankstein  10
Affiliations
Meta-Analysis

The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies: A Systematic Review and Meta-Analysis

Ankur Gupta et al. JACC Cardiovasc Imaging. 2017 Aug.

Abstract

Objectives: The aim of this study was to assess the odds of initiation or continuation of pharmacological and lifestyle preventive therapies in patients with nonzero versus zero coronary artery calcium (CAC) score detected on cardiac computed tomography.

Background: Detection of calcified coronary plaque could serve as a motivational tool for physicians and patients to intensify preventive therapies.

Methods: We searched PubMed, EMBASE (Excerpta Medica database), Web of Science, Cochrane CENTRAL (Cochrane central register of controlled trials), ClinicalTrials.gov, and the International Clinical Trials Registry Platform for studies evaluating the association of CAC scores with downstream pharmacological or lifestyle interventions for prevention of cardiovascular disease. Pooled odds ratios (ORs) of downstream interventions were obtained using the DerSimonian and Laird random effects model.

Results: After a review of 6,256 citations and 54 full-text papers, 6 studies (11,256 participants, mean follow-up time: 1.6 to 6.0 years) were included. Pooled estimates of the odds of aspirin initiation (OR: 2.6; 95% confidence interval [CI]: 1.8 to 3.8), lipid-lowering medication initiation (OR: 2.9; 95% CI: 1.9 to 4.4), blood pressure-lowering medication initiation (OR: 1.9; 95% CI: 1.6 to 2.3), lipid-lowering medication continuation (OR: 2.3; 95% CI: 1.6 to 3.3), increase in exercise (OR: 1.8; 95% CI: 1.4 to 2.4), and dietary change (OR: 1.9; 95% CI: 1.5 to 2.5) were higher in individuals with nonzero CAC versus zero CAC scores, but not for aspirin or blood pressure-lowering medication continuation. When assessed within individual studies, these findings remained significant after adjustment for baseline patient characteristics and cardiovascular risk factors.

Conclusions: This systematic review and meta-analysis suggests that nonzero CAC score, identifying calcified coronary plaque, significantly increases the likelihood of initiation or continuation of pharmacological and lifestyle therapies for the prevention of cardiovascular disease.

Keywords: cardiovascular prevention; coronary calcium score; meta-analysis.

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Figures

FIGURE 1
FIGURE 1
PRISMA Flow Diagram BPLM = blood pressure lowering medication; CAC = coronary artery calcium; CENTRAL = Cochrane central register of controlled trials; EMBASE = Excerpta Medica database; ICTRP = International Clinical Trials Registry Platform; LLM = lipid-lowering medication; PRISMA = preferred reporting items for systematic reviews and meta-analysis; RCT = randomized controlled trial.
FIGURE 2
FIGURE 2
Forest Plots and Pooled Odds Ratios for Initiation of Pharmacological Preventive Therapies CAC = coronary artery calcium; CI = confidence interval; M-H = Mantel-Haenszel.
FIGURE 3
FIGURE 3
Forest Plots and Pooled Odds Ratios for Continuation of Pharmacological Preventive Therapies Abbreviations as in Figure 2.
FIGURE 4
FIGURE 4
Forest Plots and Pooled Odds Ratios for Lifestyle Preventive Therapies Abbreviations as in Figure 2.
See this image and copyright information in PMC

Comment in

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