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Researchers found that CAC score–informed preventive strategies were tied to less plaque progression in intermediate-risk patients with familial premature CAD.

In a study of intermediate-risk patients with a family history of premature coronary artery disease (CAD), coronary artery calcium (CAC) score–informed preventive strategies were linked to significantly less plaque progression over a 3-year period, according to findings published online in JAMA.

“Coronary artery calcium (CAC) scoring provides prognostic information, especially in patients at intermediate risk for coronary artery disease (CAD).” wrote first author Nitesh Nerlekar, MBBS, MPH, PhD, of the Baker Heart and Diabetes Research Institute, and colleagues, noting that the benefit of combining CAC score with a primary prevention strategy had yet to be tested in a randomized trial.

Study Design & Participants

The team’s prospective, randomized trial enrolled 365 asymptomatic, statin-naive adults aged 40 to 70 years from seven Australian hospitals. Eligibility required a first-degree relative with CAD onset before age 60 years or a second-degree relative with CAD onset before age 50 years and a baseline CAC score between 1 and 399. Coronary CT angiography (CCTA) quantified plaque volume at baseline and at 3 years.

Participants were randomized to either:

• Usual care: Standard CAD prevention education and annual reassessment over 3 years of lipid profiles and risk factors, with statins prescribed at physician’s discretion; blinded to CAC score.
• CAC score–informed preventive care: A structured, nurse-led intervention utilizing participants’ CTA images to communicate personalized risk, coupled with self-management education, lifestyle counseling, and lipid-lowering therapy (40 mg daily atorvastatin). Follow-up occurred at 6-month intervals over 3 years.

“The intervention was based on a standardized, nurse-based intervention in which the participants’ CT images were used to communicate about disease,” the researchers explained. “The intervention included education about self-management of risk and lifestyle, care coordination, and risk modification.”

Lipid & Plaque Outcomes

At 3 years, the CAC score–informed cohort showed greater sustained lipid improvement: mean total cholesterol declined by 56 mg/dL versus 3 mg/dL in the usual care cohort, and low-density lipoprotien cholesterol level decreased by 51 mg/dL versus 2 mg/dL (both P<0.001), according to findings.

Both cohorts exhibited progressive plaque accumulation; however, the CAC score–informed group demonstrated less progression in:

• Total plaque volume
• Noncalcified plaque volume
• Fibrofatty and necrotic core volumes

These reductions were independent of baseline plaque burden and traditional risk factors, the authors noted.

Clinical Implications

“The combination of CAC score with a primary prevention strategy in intermediate-risk patients with a family history of CAD was associated with reduction of atherogenic lipids and slower plaque progression compared with usual care,” the researchers concluded. “These data support the use of CAC score to assist intensive preventive strategies in intermediate-risk patients.”