1. Coronary Artery Calcium for Risk Stratification Among Persons With Very High HDL Cholesterol
- Author
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Razavi, Alexander C, Mehta, Anurag, Wong, Nathan D, Rozanski, Alan, Budoff, Matthew J, Gianos, Eugenia, Vaccarino, Viola, van Assen, Marly, De Cecco, Carlo N, Miedema, Michael D, Rumberger, John A, Mortensen, Martin Bødtker, Shaw, Leslee J, Nasir, Khurram, Blumenthal, Roger S, Rohatgi, Anand, Quyyumi, Arshed A, Sperling, Laurence S, Whelton, Seamus P, Blaha, Michael J, Berman, Daniel S, and Dzaye, Omar
- Subjects
Epidemiology ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Cardiovascular ,Clinical Research ,Aging ,Heart Disease ,Heart Disease - Coronary Heart Disease ,Atherosclerosis ,Prevention ,2.4 Surveillance and distribution ,Good Health and Well Being ,HDL cholesterol ,cardiovascular diseases ,coronary artery calcium ,mortality ,risk assessment - Abstract
BackgroundCompared to normal high-density lipoprotein (HDL) cholesterol values, very high HDL cholesterol is associated with a higher incidence of mortality and atherosclerotic cardiovascular disease (ASCVD). As such, clinical risk stratification among persons with very high HDL cholesterol is challenging.ObjectivesAmong persons with very high HDL cholesterol, the purpose was to determine the prevalence of coronary artery calcium (CAC) and compare the association between traditional risk factors vs CAC for all-cause mortality and ASCVD.MethodsThe primary analysis was completed among 446 participants from the Cedars-Sinai Medical Center of the CAC Consortium with very high HDL cholesterol (≥77 mg/dL in men, ≥97 mg/dL in women). Cox proportional hazards regression assessed the association of CAC and traditional risk factors with all-cause mortality during a median follow-up of 10.7 years. Replication and validation analyses were performed for all-cause mortality among 119 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with very high HDL cholesterol, who also had information on incident ASCVD.ResultsThe mean age was 57.9 years old, 49% were women, and the median HDL cholesterol was 98 mg/dL. One-half of participants (50%) had prevalent CAC, in whom the median CAC score was 118. Prevalent CAC conferred a 3.6-fold higher risk of all-cause mortality (HR: 3.64; 95% CI: 1.21-11.01), which appeared to be a more robust predictor than individual traditional risk factors beyond age. In the validation sample, prevalent CAC but not individual traditional risk factors were associated with all-cause mortality (HR: 2.39; 95% CI: 1.07-5.34) and a 4.0-fold higher risk of ASCVD (HR: 4.06; 95% CI: 1.11-14.84).ConclusionsMeasurement of CAC may facilitate clinical risk assessment among individuals with very high HDL cholesterol.
- Published
- 2024