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 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 Blaha

Research output: Contribution to journalArticle

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 1 2018

Fingerprint

Carotid Intima-Media Thickness
LDL Cholesterol
Longitudinal Studies
Atherosclerosis
Health
Smoking
Logistic Models
Lipids

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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

In: Atherosclerosis, Vol. 274, 01.07.2018, p. 61-66.

Research output: Contribution to journalArticle

Al Rifai, Mahmoud ; Martin, Seth ; McEvoy, John W. ; Nasir, Khurram ; Blankstein, Ron ; Yeboah, Joseph ; Miedema, Michael ; Shea, Steven J. ; Polak, Joseph F. ; Ouyang, Pamela ; Blumenthal, Roger S ; Bittencourt, Marcio ; Bensenor, Isabela ; Santos, Raul D. ; Duncan, Bruce B. ; Santos, Itamar S. ; Lotufo, Paulo A. ; Blaha, Michael. / 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). In: Atherosclerosis. 2018 ; Vol. 274. pp. 61-66.
@article{bbb9908e64c14c77822ee97116317f04,
title = "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)",
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.",
author = "{Al Rifai}, Mahmoud and Seth Martin and McEvoy, {John W.} and Khurram Nasir and Ron Blankstein and Joseph Yeboah and Michael Miedema and Shea, {Steven J.} and Polak, {Joseph F.} and Pamela Ouyang and Blumenthal, {Roger S} and Marcio Bittencourt and Isabela Bensenor and Santos, {Raul D.} and Duncan, {Bruce B.} and Santos, {Itamar S.} and Lotufo, {Paulo A.} and Michael Blaha",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.atherosclerosis.2018.04.021",
language = "English (US)",
volume = "274",
pages = "61--66",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - The prevalence and correlates of subclinical atherosclerosis among adults with low-density lipoprotein cholesterol <70 mg/dL

T2 - The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

AU - Al Rifai, Mahmoud

AU - Martin, Seth

AU - McEvoy, John W.

AU - Nasir, Khurram

AU - Blankstein, Ron

AU - Yeboah, Joseph

AU - Miedema, Michael

AU - Shea, Steven J.

AU - Polak, Joseph F.

AU - Ouyang, Pamela

AU - Blumenthal, Roger S

AU - Bittencourt, Marcio

AU - Bensenor, Isabela

AU - Santos, Raul D.

AU - Duncan, Bruce B.

AU - Santos, Itamar S.

AU - Lotufo, Paulo A.

AU - Blaha, Michael

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85046656917&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046656917&partnerID=8YFLogxK

U2 - 10.1016/j.atherosclerosis.2018.04.021

DO - 10.1016/j.atherosclerosis.2018.04.021

M3 - Article

VL - 274

SP - 61

EP - 66

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -