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.
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
Graphical Abstract
Keywords
Abbreviations:
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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: September 27, 2019
Accepted:
September 24,
2019
Received in revised form:
September 17,
2019
Received:
July 18,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
