CorCal Outcomes trial: coronary calcium CT in 5,772 adults gave same event rate as standard risk scoring

According to portal.abczdrowie.pl, the CorCal Outcomes trial compared two ways of selecting people for statin therapy. It enrolled 5,772 patients of the US network Intermountain Health. Their mean age was 64 years, and 51% were women. None had a known atherosclerotic cardiovascular disease or diabetes, and none had taken statins before portal.abczdrowie.plportal.abczdrowie.plportal.abczdrowie.plOpen source ↗.

Participants were randomly assigned to two groups. In the first, recommendations were based on traditional risk estimation that includes cholesterol and blood pressure. In the second, the coronary artery calcium (CAC) score was used, determined by computed tomography. It shows the amount of calcification in the arteries supplying the heart and gives information about atherosclerotic changes.

Patients and their physicians received the recommendation produced by the assigned method and made the final treatment decision together.

Event rates and statin recommendations

After a mean follow-up of 4.2 years, the analyzed events occurred in 2.7% of participants in each group. The composite endpoint covered death from any cause, myocardial infarction, stroke and procedures restoring blood flow in the arteries portal.abczdrowie.plportal.abczdrowie.plportal.abczdrowie.plOpen source ↗.

At the same time, a recommendation to start statins was issued more than three times as often in the group assessed traditionally as in the group that underwent tomography.

Among those advised to take the drug on the basis of CAC, 62% adhered to the recommendation. With traditional assessment the figure was 23%. Imaging confirmation of changes may have increased motivation, but the study did not clearly explain the reason for the difference.

Limits of the result

Similar event rates do not mean the two methods were shown to be equivalent. There were fewer complications than the researchers expected, so the trial had limited power to determine whether the CAC-based strategy gives worse outcomes than traditional assessment portal.abczdrowie.plportal.abczdrowie.plportal.abczdrowie.plOpen source ↗.

The study concerned selecting people for starting prevention, not the efficacy of statins. Its results cannot be automatically applied to patients with diabetes or established cardiovascular disease, who were not included.

Calcium assessment may support individual treatment decisions, but further research is needed. The results are not a basis for stopping statins on one's own or changing a physician's recommendations.