Dislipidemia, Escore de Clcio e

incidncia de DCV
Renner Augusto Raposo Pereira
R1 de Cardiologia
Discusso de artigos UNLIP

Objetivo
In considering its potential role in such algorithms, the
question arises: how well does CAC stratify risk across
dyslipidemia categories?
Therefore, we sought to evaluate the interplay
between CAC and dyslipidemia in relation to CVD
outcomes in the Multi-Ethnic Study of Atherosclerosis
(MESA).
We hypothesized that
1) many subjects with dyslipidemia would have no CAC and
vice versa, and that
2) CAC would consistently stratify CVD risk across
categories of dyslipidemia.

MTODOS

Mtodos
Participantes:
Detalhes do estudo MESA

Mtodos
CAC measurements, Lipid Measurements, Non-lipid Risk Factors
Ascertainment of Incident CVD
CVD events included myocardial infarction, angina resulting in
revascularization, resuscitated cardiac arrest, stroke, or cardiovascular
death
Hard CVD events: sem angina com revacularizao

Statistical Analysis
CAC=0, CAC 1-99, CAC 100.
Nmero de anormalidades lipdicas (LA)
LDL-C > 130 mg/dL
HDL-C < 40 mg/dL for men or < 50 mg/dL for women,
TG > 150 mg/dL

Quartis do CT/HDL-c

RESULTADOS

Study Population by LA

Baseline characteristics of the study

cohort by LA burden

CAC Distribution by Dyslipidemia

Categories

Nmero de anormalidades lipdicas

CAC Distribution by Dyslipidemia

Categories

Quartis de CT/HDL-c

CVD rate (1,000 person-years )

Number of LA
0 LA:
1 LA:
2 LA:
3 LA:

7.1 (95% CI 5.8-8.7)

9.3 (95% CI 7.8-11.0)
11.6 (95% CI 9.5-14.2)
13.9 (95% CI 9.8-19.8)

CAC
CAC = 0:
CAC 1-99:
CAC 100:

3.0 (95% CI 2.4-3.9)

9.8 (95% CI 8.0-12.0) and
26.5 (95% CI 23.0-30.5)

Hard CVD events

Overall, 256 (5%) hard CVD events (excludes angina leading
to revascularization) occurred during 7.6 years of median
follow-up. CAC > 0: 202 events (79%). Half of events (128)
occurred in the 21% of participants with CAC 100.
Absolute incident hard CVD event rates were 1.8%, 5.3%
and 11.1% among those with CAC=0, CAC 1-99 with CAC
100.
Hard CVD event rates were per 1000 person-years for those
2.5 (95% CI 1.9-3.3) - CAC=0
7.7 (95% CI 6.1-9.6) - CAC 1-99
16.9 (95% CI 14.2-20.1) - CAC 100

DISCUSSO

Discusso
Avaliao: dyslipidemia (risk factor) X CAC
(measurable atherosclerosis)
Ateno:
many individuals with dyslipidemia have no CAC,
while many individuals without dyslipidemia have
CAC
CAC stratifies CVD risk regardless of the burden of
dyslipidemia and regardless of how dyslipidemia is
defined

Taxa de eventos: CAC > 100 = Prev. secundria

 Allocating Statin Therapy: To Prevent Events,

There Must Be Events
Normal Lipids but Detectable CAC
Normal relativo
Biologicamente normal e Ideal clinicamente
Benefcio independente do perfil lipdico basal
1 em 5 pacientes de DLP tem CAC > 100
Consequncias na conduta
Melhor estratificao de risco

 Dyslipidemia but CAC=0

3 LA e CAC=0
CVD < 5% em 7,6 anos
Menos de 1/3 do risco de 0 LA e CAC > 100

Apesar de CAC = 0, os eventos ocorrem:

CAC no avalia placas no calcificadas
Fotografia do momento

Proposta ao paciente de tratar evoluo de

aterosclerose e no eventos precoces

 Estimating the Number Needed to Treat

Usando dados de trials prvios
MESA cohort ranges from 23 to 30 in those with
CAC
CAC > 100 e LA=0 NNT=30
CAC=0 e LA=3 NNT=154
Valor dessa extrapolao questionvel (no foram
analisados subgrupos de CAC)

 Integrating into the Framingham Approach

Risco individual pelos fatores de risco tradicionais

CAC refina estratificao do Framingham
Risco intermedirio: CAC o melhor
Dallas Heart Study: risco intermedirio
F: 1% -> 0,1% com CAC > 400
M: 15% 1,1% com CAC > 400
MESA: baixo risco
CAC > 0 foram 32%
HR=5.2 - 95% CI 2.5-10.8

CAC promissor e exige estudos delineados para tal

 Limitations
CAC:
Financeira
Exposio a radiao
Achados incidentais no cardacods (ex: NPS)

Estudo:
Cincia do CAC pelo paciente e mdico
Desenhado para avaliao de estratificao de risco
No prev melhora de resultados com incorporao
No avaliar custo-efetividade

CONCLUSO

Concluso
Avaliao de aterosclerose pelo CAC
Parece estratificar risco no espectro de
dislipidemia no grupo estudado

CAC pode ajudar a personalizar conduta

Pesar risco beneficio do uso de estatina
Direcionar esforos para alcanar metas

Obrigado!