A recent analysis of MESA (the largest government funded heart study in recent years) shows coronary plaque detection (by coronary calcium scoring) as recommended by SHAPE Task Force is best for prediction of response to aspirin for prevention of heart attack.

As reported by Medscape of WebMD, predicted benefit from daily aspirin therapy for primary prevention exceeds risk when coronary artery calcium (CAC) imaging scores reach or exceed 100, whereas the risks surpass benefits at a CAC score of 0, in both cases regardless of risk by Framingham criteria, suggests analysis of a Multi-Ethnic Study of Atherosclerosis (MESA) cohort[1]. Those with CAC scores of 0 or >100 accounted for three-fourths of the ethnically diverse (only 37% white) population of >4200 nondiabetic persons not on aspirin at baseline.

The MESA analysis complements other research, including another from a MESA cohort published three years ago (and reported then by heartwire ), that concludes similarly about CAC scores and statin therapy, Miedema observed. In it, CAC scores using much the same cutoff values as the current analysis, in a statin-eligible cohort that would have qualified for the JUPITER trial, effectively stratified patients for risk of CVD and CHD events.

“These findings, combined with the results of our analysis, suggest that CAC may be useful in determining the potential benefit of both aspirin and statin therapy, thus increasing the use of CAC as a tool for improved clinical decision making,” he and his colleagues write.

The group looked at 4229 MESA participants, without diabetes and not on aspirin at baseline, according to CAC scores and outcomes over the study’s follow-up, averaging 7.6 years. After adjustment for potential confounders and other features, including Framingham risk level, the hazard ratios (HR) for “hard” CHD events (including nonfatal MI, resuscitated cardiac arrest, and CHD death) and of hard CVD events (including CHD events and fatal and nonfatal stroke) for CAC >100 vs CAC=0 went up by factors of 4 and nearly 3, respectively.

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