Atherosclerotic cardiovascular disease events among statin eligible individuals with and without long-term healthy arterial aging

Alexander C. Razavi, Tanika N. Kelly, Matthew J. Budoff, Lydia A. Bazzano, Jiang He, Camilo Fernandez, Joao Lima, Khurram Nasir, Roger S. Blumenthal, Michael J. Blaha, Seamus P. Whelton

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background and aims: A large proportion of statin eligible candidates have a baseline absence of coronary artery calcium (CAC) and low 10-year atherosclerotic cardiovascular disease (ASCVD) risk. We sought to determine the proportion of statin eligible individuals who had long-term healthy arterial aging (persistent CAC = 0) and their examined 15-year ASCVD outcomes. Methods: We included 561 statin eligible candidates from the Multi-Ethnic Study of Atherosclerosis who were not on statin therapy with CAC = 0 at Visit 1 (2000-02) and underwent a subsequent CAC scan at Visit 5 (2010-11). Adjusted Cox proportional hazards regression assessed the association between persistent CAC = 0 and ASCVD events over 15.9 years. Results: Participants were on average 61.7 years old, 50% were women, and 43% maintained long-term CAC = 0. Individuals with an LDL-C ≥190 mg/dL (54%) and those with an ASCVD risk ≥20% (33%) had the highest and lowest proportion of persistent CAC = 0, respectively. There were 57 ASCVD events, and 15-year ASCVD event rates were low for individuals with and without healthy arterial aging (4.3 versus 8.6 per 1,000 persons-years), but the 10-year number needed to treat to prevent one ASCVD event differed by more than two fold (117 versus 54). In multivariable modeling, persistent CAC = 0 conferred a 51% lower risk of ASCVD compared to those with incident CAC (HR = 0.49, 95% CI: 0.27–0.90, p=0.02). Conclusions: More than 40% of statin eligible individuals with baseline CAC = 0 had long-term healthy arterial aging. Statin eligible candidates with persistent CAC = 0 had a very low 15-year ASCVD risk, suggesting that statin therapy may be of limited benefit among this group of individuals.

Original languageEnglish (US)
Pages (from-to)56-62
Number of pages7
StatePublished - Jun 2021


  • Aging
  • Cardiovascular diseases
  • Coronary artery calcium
  • Multidetector computed tomography
  • Prevention
  • Statins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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