Statin eligibility and cardiovascular risk burden assessed by coronary artery calcium score: Comparing the two guidelines in a large Korean cohort

•Applying the new ACC/AHA guideline increased the statin-eligible population from 18.7% to 21.7% as defined by ATP III in Korean health screening cohort.•Statin-eligible subjects as defined by ACC/AHA guideline manifested a higher proportion of subjects with CAC compared with those meeting ATP-III criteria for statin treatment.•ACC/AHA guideline demonstrated better prediction for CAC compared with ATP III guideline with higher odds ratio for cardiovascular disease.

ObjectiveTo investigate the statin eligibility and the predictabilities for cardiovascular disease between AHA/ACC and ATPIII guidelines, comparing those results to concomitant coronary artery calcium scores (CACS) in a large cohort of Korean individuals who met statin-eligibility criteria.MethodsAmong 19,920 participants in a health screening program, eligibility for statin treatment was assessed by the two guidelines. The presence and extent of coronary artery calcification (CAC) was measured by multi-detector computed tomography and compared among the various groups defined by the two guidelines.ResultsApplying the new ACC/AHA guideline to the health screening cohort increased the statin-eligible population from 18.7% (as defined by ATP III) to 21.7%. Statin-eligible subjects as defined only by ACC/AHA guideline manifested a higher proportion of subjects with CAC compared with those meeting only ATP-III criteria even after adjustment for age and sex (47.1 vs. 33.8%, p < 0.01). Statin-eligible subjects as defined by ACC/AHA guideline showed higher odds ratio for the presence of CACS > 0 compared with those meeting ATP-III criteria {3.493 (3.245 ∼ 3.759) vs. 2.865 (2.653 ∼ 3.094)}, which was attenuated after adjusted for age and sex.ConclusionsIn this large Korean cohort, more subjects would have qualified for statin initiation under the new ACC/AHA guideline as compared with the proportion recommended for statin treatment by ATP III guideline. Among statin-eligible Korean health screening subjects, the new ACC/AHA guideline identified a greater extent of atherosclerosis as assessed by CACS as compared to ATP III guideline assessment.