Clinical significance of zero coronary artery calcium in individuals with LDL cholesterol ≥190 mg/dL: The Multi-Ethnic Study of Atherosclerosis. (January 2020)

• Record Type: Journal Article
• Authors: Sandesara, Pratik B.; Mehta, Anurag; O'Neal, Wesley T.; Kelli, Heval M.; Sathiyakumar, Vasanth; Martin, Seth S.; Blaha, Michael J.; Blumenthal, Roger S.; Sperling, Laurence S.
• Is Part Of: Atherosclerosis. Volume 292(2020)
• Page Start: 224
• Page End: 229
• Publication Date: 2020-01
• Subjects: Cholesterol -- Risk factors -- Coronary calcium -- Outcomes; ASCVD atherosclerotic cardiovascular disease -- CAC coronary artery calcium -- CHD coronary heart disease -- Hs-CRP high-sensitivity C-reactive protein -- MESA Multi-Ethnic Study of Atherosclerosis -- RR relative risk; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2019.09.014
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Individuals with low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL are considered high-risk and current guidelines recommend initiating high-intensity statin therapy in this group. We sought to examine the predictive ability of zero CAC in this high-risk group. Methods: Multi-Ethnic Study of Atherosclerosis participants without clinical cardiovascular disease and baseline LDL-C ≥190 mg/dL were identified. Cardiovascular risk factors were compared between those with CAC = 0 and CAC >0. Multivariable Poisson regression was used to identify predictors of CAC = 0. Association of CAC = 0 with incident cardiovascular events over a median follow-up of 13.2 years was examined using multivariable-adjusted Cox regression. Results: 246 individuals (mean age = 63 ± 9.4 years; 42% male; 31% white; 37% CAC = 0) with LDL-C ≥190 mg/dL were identified (mean LDL-C = 215 ± 27 mg/dL). Age <65 years (RR = 2.17, 95%CI = 1.49–3.23), female sex (RR = 2.10, 95%CI = 1.42–3.10), and no diabetes (RR = 2.22, 95%CI = 1.18–4.17) were associated with CAC = 0. Individuals with CAC = 0 had a lower risk for future cardiovascular events (incidence rate per 1000 person-years = 4.7; 10-year risk = 3.7%; risk/year = 0.4%) than those with CAC >0 (incidence rate per 1000 person-years = 26.4; 10-year risk = 20%; risk/year = 2.0%), adjusted HR 0.25 (95%CI = 0.10–0.66). Conclusions: Among persons with LDL-C ≥190 mg/dL, younger age, female sex, and the absence of diabetes were associated with CAC = 0. CAC = 0 was associated with a low risk of cardiovascular events, suggesting the utility of CAC assessment for stratifying risk in this high-risk group. Graphical abstract: Image 1 Highlights: Asymptomatic individuals with LDL-C ≥190 mg/dL are considered high-risk for future cardiovascular events. Distribution of risk factors in these individuals is heterogeneous and varies by the presence or absence of CAC. In MESA participants with LDL-C ≥190 mg/dL, younger age, female sex, and lack of diabetes were associated with absence of CAC. Absence of CAC was independently associated with better cardiovascular outcomes in this MESA sub-group. Absence of CAC may help 'de-risk' individuals in this high-risk patient population.