At this point we suggest repeating the vascular imaging examination every 5 years, which is about the mean follow-up in previous randomized clinical studies, during which no major cardiovascular event occurred in these very-low-risk patients. Further prospective

studies are required to determine if and when repeated examination is required, but this time-frame Inhibitors,research,lifescience,medical is reasonable in light of the position stated by the panel of radiologists who recommended that patients who have normal carotid ultrasound (US) studies but marked risk factors, thus not low risk, might be evaluated every 3–5 years.15 In Israel, many thousands of subjects with very low FRS (less than 6%), mostly women, are treated with statins (personal knowledge). Inhibitors,research,lifescience,medical In a recently published study,16 half of low-risk patients who underwent CCTA showed no vascular pathology. Thus, a large proportion of subjects from this category will be treated

with statins, and, of these subjects, at least 10%–15% suffer from myopathy but are still encouraged by their physicians to continue the medication. We suggest that in these very-low-risk subjects, if vascular imaging shows no CAC or normal CIMT without plaques, statin treatment need not be administered, with the exception of subjects with Inhibitors,research,lifescience,medical low FRS with a family history of CAD at young age. In our view, vascular imaging is also cost-effective, especially in the long run. The cost of CT for evaluation of CAC or Inhibitors,research,lifescience,medical US carotid artery examination in our institution is about $130, which is about the equivalent of 1 year of treatment with low-dose generic statins, blood tests, and visits to the physician. In summary, we suggest using vascular imaging as a method to reduce significantly the number of subjects who, in our opinion, would not benefit from Inhibitors,research,lifescience,medical statins and only suffer from their side-effects. As P.K. Shah has previously well formulated17:

“If the goal of using a statin is to reduce atherothrombotic cardiovascular events, then it is unrealistic to expect those patients without significant I-BET151 supplier atherosclerosis to benefit from statin therapy even if they have hyperlipidemia. In such subjects, one can only expect side effects.” Abbreviations: CAC coronary artery calcification; CAD coronary artery disease; CCTA cardiac CT angiography; CIMT carotid artery intima-media thickness; CV cardiovascular; CVD cardiovascular disease; FRS Framingham Risk Score; US ultrasound. Footnotes almost Conflict of interest: No potential conflict of interest relevant to this article was reported.
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