Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA. https://doi.org/10.1001/jama.2025.0584 Dr. Nitesh Nerlekar et al.
Points
- The study assessed the impact of coronary artery calcium (CAC) scoring combined with a targeted prevention strategy in intermediate-risk patients with a family history of premature coronary artery disease (CAD).
- 365 participants (aged 40-70) were randomized into two groups: one received CAC score-informed care with 40 mg atorvastatin and targeted prevention, while the other followed standard care recommendations.
- The CAC-informed group showed a more significant reduction in total cholesterol (−56 mg/dL vs. −3 mg/dL; P < 0.001) and LDL cholesterol (−51 mg/dL vs. −2 mg/dL; P < 0.001) compared to the usual care group.
- The CAC-informed group had significantly lower progression in total plaque volume (mean difference: −9.5 mm³; P = 0.009), noncalcified plaque (−10.1 mm³; P = 0.002), and fibrofatty and necrotic core plaque (−5.3 mm³; P = 0.02).
- The findings suggest that CAC scoring can guide personalized prevention strategies, leading to improved lipid management and reduced plaque progression in patients with a family history of premature CAD.
Summary
This study aimed to assess the impact of coronary artery calcium (CAC) scoring combined with a preventive strategy in intermediate-risk patients with a family history of premature coronary artery disease (CAD). A total of 365 participants, aged 40 to 70 years, with a family history of early-onset CAD, were recruited and randomized to receive either CAC score-informed care or usual care. Participants in the CAC-informed group received 40 mg of atorvastatin and targeted prevention strategies based on their CAC scores, while those in the usual care group followed standard recommendations. Follow-up coronary computed tomography angiography (CCTA) was performed after 3 years to evaluate plaque progression.
Results showed that the CAC-informed group experienced a significantly greater reduction in total cholesterol (−56 mg/dL vs. −3 mg/dL; P < 0.001) and low-density lipoprotein (LDL) cholesterol (−51 mg/dL vs. −2 mg/dL; P < 0.001) compared to the usual care group. This was associated with a notable reduction in plaque progression. The CAC-informed group had lower progression in total plaque volume (mean difference: −9.5 mm3; P = 0.009), noncalcified plaque volume (mean difference: −10.1 mm3; P = 0.002), and fibrofatty and necrotic core plaque volume (mean difference: −5.3 mm3; P = 0.02) compared to the usual care group. These benefits were independent of baseline plaque volume, blood pressure, and lipid profile.
The study concluded that combining CAC scoring with a targeted prevention strategy was associated with significant reductions in atherogenic lipids and slower plaque progression compared to usual care in intermediate-risk patients. These findings support the use of CAC scoring in guiding preventive strategies for individuals with a family history of premature CAD, potentially leading to better cardiovascular outcomes through personalized care.
Link to the article: https://jamanetwork.com/journals/jama/article-abstract/2831115
References Nerlekar, N., Vasanthakumar, S. A., Whitmore, K., Soh, C. H., Chan, J., Goel, V., Ryan, J., Jones, C., Stanton, T., Mitchell, G., Tonkin, A., Watts, G. F., Nicholls, S. J., Marwick, T. H., Coronary Artery Calcium Score: Use to Guide Management of Hereditary Coronary Artery Disease (CAUGHT-CAD) Investigators, Pathan, F., Negishi, K., Abraham, A., Playford, D., … Otahal, P. (2025). Effects of combining coronary calcium score with treatment on plaque progression in familial coronary artery disease: A randomized clinical trial. JAMA. https://doi.org/10.1001/jama.2025.0584
