Low CAC, galectin-3 tied to low cardiovascular risk in elderly adults
Among elderly adults, those with coronary artery calcium (CAC)=0, CAC ≤10, low galectin-3 or no carotid plaque have significantly low cardiovascular risk, a study has shown. This calls into question the suitability of a treat-all approach in this population.
The strongest negative risk markers were CAC=0 and CAC ≤10, with mean diagnostic likelihood ratios (DLRs) of 0.20 and 0.20 for coronary heart disease (ie, 80-percent lower risk than expected from traditional risk factor assessment) and 0.41 and 0.48 for cardiovascular disease, respectively. This was followed by galectin-3 <25th percentile (DLR, 0.44 and 0.43, respectively) and absence of carotid plaque (DLR, 0.39 and 0.65, respectively). Other markers obtained less remarkable results.
CAC=0 (net reclassification index [NRI], 0.23) and CAC ≤10 (NRI, 0.28) also showed the largest accurate downward risk reclassification across the class I statin-eligibility threshold defined by the American College of Cardiology/American Heart Association. This was followed by galectin-3 <25th percentile (NRI, 0.14) and absence of carotid plaque (NRI, 0.08).
A total of 13 candidate markers were evaluated in 5,805 BioImage participants (mean age, 69 years; median follow-up, 2.7 years), namely CAC=0, CAC ≤10, no carotid plaque, no family history, normal ankle-brachial index, test result <25th percentile (carotid intima-media thickness, apolipoprotein B, galectin-3, high-sensitivity C-reactive protein, lipoprotein(a), N-terminal pro–B-type natriuretic peptide and transferrin) and apolipoprotein A1 >75th percentile. Patient-specific DLR and binary NRI were used to compare negative marker performance.
“Cardiovascular risk increases dramatically with age, leading to nearly universal risk-based statin eligibility in the elderly population,” the authors said. “To limit overtreatment, elderly individuals at truly low risk need to be identified.”