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Atherosclerosis. 2019 Sep 27. pii: S0021-9150(19)31501-1. doi: 10.1016/j.atherosclerosis.2019.09.014. [Epub ahead of print]

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

Author information

1
Department of Medicine, Division of Cardiology, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, USA. Electronic address: psandes@emory.edu.
2
Department of Medicine, Division of Cardiology, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, USA.
3
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 601 North Caroline Street, Baltimore, MD, USA.
4
Department of Medicine, Division of Cardiology, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, USA; Emory Heart Disease Prevention Center, Executive Park, 1605 Chantilly Drive Northeast, Atlanta, GA, USA.

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.

KEYWORDS:

Cholesterol; Coronary calcium; Outcomes; Risk factors

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