Very high LDL: what does zero CAC add to the risk equation?

  • Sandesara PB & al.
  • Atherosclerosis
  • 27 Sep 2019

  • International Clinical Digest
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Takeaway

  • With low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL, coronary artery calcium (CAC) of zero points to relatively lower risk for cardiovascular disease (CVD)-related events.

Why this matters

  • The population with very high LDL-C is not at uniformly high CVD event risk, and zero CAC adds to the risk calculation.
  • Recommendations call for high-intensity statin therapy in patients with these LDL-C values.

Key results

  • Being younger (
  • With zero CAC vs >0 CAC, CVD event risk was reduced: adjusted (a)HR, 0.25 (95% CI, 0.10-0.66).
  • With zero CAC:
    • CVD event incident rate: 4.7 vs 26.4 per 1000 person-years with >0 CAC.
    • 10-year risk: 3.7% vs 20%.
  • Incidence rates of coronary heart disease events (aHR, 0.29; P=.026) and death (aHR, 0.34; P=.053) were also lower with zero CAC vs >0 CAC.

Study design

  • 246 people from the Multi-Ethnic Study of Atherosclerosis cohort who had LDL-C ≥190 mg/dL.
  • Median follow-up, 13.2 years.
  • Funding: National Heart, Lung, and Blood Institute; others.

Limitations

  • LDL-C values were adjusted to statin therapy; cause of LDL-C elevation was not determined.
  • Event rate was low, group numbers were small.

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