Serum Lipoproteins Are Associated With Coronary Atherosclerosis in Asymptomatic U.S. Adults Without Traditional Risk Factors

• Published in: JACC. Advances (Online) Vol. 3; no. 7; p. 101049
• Main Authors: Faridi, Kamil F., Lahan, Shubham, Budoff, Matthew J., Cury, Ricardo C., Feldman, Theodore, Pan, Alan P., Fialkow, Jonathan, Nasir, Khurram
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024; Elsevier
• Subjects: atherosclerosis; Cardiovascular; coronary CTA; low-risk adults; prevalence; prevention; atherosclerosis; HDL-C; prevalence; CCTA; low-risk adults; CAC; ASCVD; LDL-C; coronary CTA; prevention; apoB; coronary computed tomography angiography; low-density lipoprotein cholesterol; atherosclerotic cardiovascular disease; coronary artery calcification; high-density lipoprotein cholesterol; apolipoprotein B
• ISSN: 2772-963X; 2772-963X
• DOI: 10.1016/j.jacadv.2024.101049

The relationship between atherogenic lipoproteins and subclinical coronary atherosclerosis has not been thoroughly evaluated in low-risk adults. The purpose of this study was to assess the association of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (HDL-C), and apolipoprotein B (apoB) with coronary atherosclerosis in adults without traditional risk factors. We assessed atherosclerosis on coronary computed tomography angiography among asymptomatic adults in the Miami Heart Study not taking lipid-lowering therapy and without hypertension, diabetes, or active tobacco use. Prevalence of atherosclerosis was evaluated based on serum LDL-C, non-HDL-C, and apoB, and multivariable logistic regression with forward selection was used to assess variables associated with coronary plaque. Among 1,033 adults 40 to 65 years of age, 55.0% were women and 86.3% had estimated 10-year atherosclerotic cardiovascular disease risk <5%. Coronary atherosclerosis prevalence was 35.9% (50.6% in men; 23.8% in women) and 3.4% had ≥1 high-risk plaque feature. Atherosclerosis prevalence increased with LDL-C, ranging from 13.2% in adults with LDL-C <70 mg/dL up to 48.2% with ≥160 mg/dL. Higher LDL-C (adjusted OR [aOR]: 1.13 [95% CI: 1.08-1.18] per 10 mg/dL), age (aOR: 1.43 [95% CI: 1.28-1.60] per 5 years), male sex (aOR: 3.81 [95% CI: 2.86-5.10]), and elevated lipoprotein(a) (aOR: 1.46 [95% CI: 1.01-2.09]) were associated with atherosclerosis. Higher serum non-HDL-C and apoB were similarly associated with atherosclerosis. In adults with optimal risk factors, 21.2% had atherosclerosis with greater prevalence at higher lipoprotein levels. Among asymptomatic middle-aged adults without traditional risk factors, coronary atherosclerosis is common and increasingly prevalent at higher levels of atherogenic lipoproteins. These findings emphasize the importance of lipid-lowering strategies to prevent development and progression of atherosclerosis regardless of risk factors. [Display omitted]