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

Pratik B. Sandesara, Anurag Mehta, Wesley T. O'Neal, Heval M. Kelli, Vasanth Sathiyakumar, Seth Martin, Michael Blaha, Roger S Blumenthal, Laurence S. Sperling

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalAtherosclerosis
DOIs
StateAccepted/In press - Jan 1 2019

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LDL Cholesterol
Atherosclerosis
Coronary Vessels
Calcium
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Aptitude
Group Psychotherapy
Cardiovascular Diseases
Guidelines
Incidence

Keywords

  • Cholesterol
  • Coronary calcium
  • Outcomes
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical significance of zero coronary artery calcium in individuals with LDL cholesterol ≥190 mg/dL : The Multi-Ethnic Study of Atherosclerosis. / Sandesara, Pratik B.; Mehta, Anurag; O'Neal, Wesley T.; Kelli, Heval M.; Sathiyakumar, Vasanth; Martin, Seth; Blaha, Michael; Blumenthal, Roger S; Sperling, Laurence S.

In: Atherosclerosis, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Clinical significance of zero coronary artery calcium in individuals with LDL cholesterol ≥190 mg/dL: The Multi-Ethnic Study of Atherosclerosis",
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",
author = "Sandesara, {Pratik B.} and Anurag Mehta and O'Neal, {Wesley T.} and Kelli, {Heval M.} and Vasanth Sathiyakumar and Seth Martin and Michael Blaha and Blumenthal, {Roger S} and Sperling, {Laurence S.}",
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T1 - Clinical significance of zero coronary artery calcium in individuals with LDL cholesterol ≥190 mg/dL

T2 - The Multi-Ethnic Study of Atherosclerosis

AU - Sandesara, Pratik B.

AU - Mehta, Anurag

AU - O'Neal, Wesley T.

AU - Kelli, Heval M.

AU - Sathiyakumar, Vasanth

AU - Martin, Seth

AU - Blaha, Michael

AU - Blumenthal, Roger S

AU - Sperling, Laurence S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Cholesterol

KW - Coronary calcium

KW - Outcomes

KW - Risk factors

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