The prevalence and correlates of subclinical atherosclerosis among adults with low-density lipoprotein cholesterol <70 mg/dL: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Mahmoud Al Rifai, Seth S. Martin, John W. McEvoy, Khurram Nasir, Ron Blankstein, Joseph Yeboah, Michael Miedema, Steven J. Shea, Joseph F. Polak, Pamela Ouyang, Roger S. Blumenthal, Marcio Bittencourt, Isabela Bensenor, Raul D. Santos, Bruce B. Duncan, Itamar S. Santos, Paulo A. Lotufo, Michael J. Blaha

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims: The prevalence and correlates of subclinical atherosclerosis when low-density lipoprotein cholesterol (LDL-C) levels are low remain unclear. Therefore, we examined the association of cardiovascular risk factors and subclinical atherosclerosis among individuals with untreated LDL-C <70 mg/dL. Methods: We included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohorts. To optimize accuracy, LDL-C was calculated by the validated Martin/Hopkins equation that uses an adjustable factor for the ratio of triglycerides to very low-density lipoprotein cholesterol. We defined subclinical atherosclerosis as a coronary artery calcium (CAC) score >0 in the combined cohort or common carotid intima media thickness (cIMT) in the 4th quartile, using cohort-specific cIMT distributions at baseline. Logistic regression models examined the cross-sectional associations of cardiovascular risk factors and subclinical atherosclerosis. Results: Among 9411 participants not on lipid lowering therapy, 263 (3%) had LDL-C <70 mg/dL (MESA: 206, ELSA: 57). Mean age in this population was 58 (SD 12) years, with 43% men, and 41% Black. The prevalence of CAC >0 in those with untreated LDL-C<70 mg/dL was 30%, and 18% were in 4th quartile of cIMT. In demographically adjusted models, only ever smoking was significantly associated with both CAC and cIMT. Similar results were obtained in risk factor-adjusted models (smoking: OR, 2.29; 95% CI, 1.10–4.80 and OR, 3.44; 95% CI, 1.41–8.37 for CAC and cIMT, respectively). Conclusions: Among middle-aged to older individuals with untreated LDL-C <70 mg/dL, subclinical atherosclerosis remains moderately common and is associated with cigarette smoking.

Original languageEnglish (US)
Pages (from-to)61-66
Number of pages6
JournalAtherosclerosis
Volume274
DOIs
StatePublished - Jul 2018

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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