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LDL-C, CAC Scores & Risk of Atherosclerotic Cardiovascular Disease Events

LDL cholesterol is a predictor of future atherosclerotic cardiovascular disease (ASCVD) events in middle-aged people “almost exclusively” when there is evidence of coronary atherosclerosis based on coronary artery calcification (CAC) scores, a registry-based study concludes.

The Western Denmark Heart Registry provided the records for 23,132 consecutive symptomatic patients evaluated for coronary artery disease using computed tomography angiography (CTA). Cox regression models were used to assess the association of LCL-C levels taken before CTA with ASCVD events (myocardial infarction and ischemic stroke) with stratification by CAC = 0 and CAC >0.

“During a median follow-up of 4.3 years, 552 patients experienced a first ASCVD event,” the researchers report. “In the overall population, LDL-C (per 38.7 mg/dL increase) was associated with ASCVD events occurring during follow-up (adjusted hazard ratio [aHR], 1.14 [95% CI, 1.04–1.24]). When stratified by the presence or absence of baseline CAC, LDL-C was only associated with ASCVD in the 10,792/23,132 patients (47%) with CAC >0 (aHR, 1.18 [95% CI, 1.06–1.31]); no association was observed among the 12,340/23,132 patients (53%) with CAC = 0 (aHR, 1.02 [95% CI, 0.87–1.18]). Similarly, a very high LDL-C level (>193 mg/dL) versus LDL-C <116 mg/dL was associated with ASCVD in patients with CAC >0 (aHR, 2.42 [95% CI, 1.59–3.67]) but not in those without CAC (aHR, 0.92 [0.48–1.79]). In patients with CAC = 0, diabetes, current smoking, and low high-density lipoprotein cholesterol levels were associated with future ASCVD events. The principal findings were replicated in the Multi-Ethnic Study of Atherosclerosis.”

Source: Circulation