Translating to outcomes is important in my opinion.
eg even w/ 1/4 of cohort of 6.5k w/ CAC 0, sizable # w/ soft plaque, MACE <0.1%/year over 6.6 years.
I think a "don't worry for now..." is a subtle strawman - I would frame it as "there is no guarantee but based on the available evident, in the absence some features (eg HTN, IR, DM, ?lp(a) w/ fam hx, inflammatory dz, smoking), you appear to be at a quite low risk over the next at least 5 years and there appears to be no a/w statin use and lower outcomes over 10 years. If you elect to defer a medication and want to rescan in 3-5 years, that may be reasonable in this circumstance based on the available evidence."
CAC conversion is usually minimal at rescan, 95% of low risk w/ CAC 0 have <10 at 4.8 yrs.
re: "studies/post hoc analysis looking at the impact..." - do you have some in mind?
Walter Reed has a NNT10 of 3751 to infinity for CAC 0 w/ statin...
re: "This study is perhaps..." - I think this is an overreach.
This was an overall IR (TG 120s) cohort w/ 1/4 w/ HTN, 15% h/o smoking, no multivariable regression analysis for progression, no CAC stratification.
I think Mike's idea (which I just read the preview of the article) is loosely akin to swabbing a heterogeneous group of people for skin bacteria: some are mildly immunocompromised, some are healthy, some live in low-exposure environment, some work on farms or in factories, finding some relatively normal bacteria that could possibly cause infection on everyone's skin swab, seeing that some get mild (perhaps self-limiting) infections and concluding everyone needs an antibiotic with bacteria on the skin, even if they have no evidence of any scrapes on the skin or correlating bacteria with the progression of mild infection, let alone cellulitis or sepsis.
It might be smart to give antibotics to the immunocompromised folks who are putting up barbed wire fences all day and live with kids who go to day care - benefits>>>risks.
Not perfect analogy. But I'd prefer to identify those who have more scrapes and specifically features that indicate that they are high risk for mod-severe infection requiring antibiotics, try to reverse an immunocompromised state, make them wear safety gear, and if they get recurrent self-limiting mild infections, we get a C/S to target the antibiotic to them, use it for the appropriate duration, etc. etc. etc.
This is precision medicine, not spray and pray. Patients deserve better refinement.
I think you get the point.