TY - JOUR
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 S.
AU - Blaha, Michael J.
AU - Blumenthal, Roger S.
AU - Sperling, Laurence S.
N1 - Funding Information:
This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute . PBS, AM, and HMK are supported by the Abraham J. & Phyllis Katz Foundation (Atlanta, GA). AM is supported by the American Heart Association under grant number 19POST34400057 . WTO is supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under award number F32-HL134290 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2020/1
Y1 - 2020/1
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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U2 - 10.1016/j.atherosclerosis.2019.09.014
DO - 10.1016/j.atherosclerosis.2019.09.014
M3 - Article
C2 - 31604582
AN - SCOPUS:85073029601
SN - 0021-9150
VL - 292
SP - 224
EP - 229
JO - Atherosclerosis
JF - Atherosclerosis
ER -