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Published on: August 28, 2018
The Risk of Coronary Artery Calcification according to Different Lipid Parameters and Average Lipid Parameters
Tae Kyung Yoo1, Mi Yeon Lee2, Ki-Chul Sung3
1Department of Medicine, MetroWest Medical Center.
Insights
High apolipoprotein B (ApoB) levels strongly predict coronary artery calcification (CAC) risk. Baseline lipid parameters are as effective as average measurements in predicting CAC development.
Area of Science:
- Cardiovascular disease research
- Lipid metabolism and atherosclerosis
- Medical imaging and diagnostics
Background:
- Coronary artery calcification (CAC) is a marker of atherosclerosis.
- Lipid parameters are known risk factors for cardiovascular disease.
- Understanding the predictive power of different lipid measures for CAC is crucial for risk stratification.
Purpose of the Study:
- To compare the association between baseline and time-averaged lipid parameters with coronary artery calcification (CAC) risk.
- To evaluate the predictive efficacy of various lipid profiles, including apolipoprotein B (ApoB), for incident CAC.
Main Methods:
- Analysis of data from 29,278 participants with serial CAC measurements and baseline CAC of 0.
- Measurement and calculation of lipid parameters: ApoB, ApoA1, non-HDL-C, LDL-C, TC, TG, and remnant cholesterol (RC).
- Cox proportional hazard modeling was used to assess CAC risk across lipid quartiles, adjusting for confounders.
Main Results:
- The highest quartile of ApoB demonstrated a significantly strong association with increased CAC risk (HR 2.72) compared to the lowest quartile.
- Remnant cholesterol (RC) showed a modest association with CAC risk (Q4 HR 1.7).
- The predictive strength for CAC was comparable between baseline lipid levels and average lipid levels over time.
Conclusions:
- Elevated apolipoprotein B (ApoB) levels are strongly associated with a higher risk of developing coronary artery calcification.
- Baseline lipid measurements are as effective as averaged lipid values over time for predicting CAC development.
Aim:
We compared the association between the baseline and average lipid parameters over time and the coronary artery calcification (CAC) risk.
Methods:
Participants who underwent annual (biannual) health examinations and coronary artery computed tomography to measure CAC at least twice between March 2010 and December 2019, with a baseline CAC of 0, were included. The levels of apolipoprotein B (ApoB), Apolipoprotein A-I (ApoA1), ApoB/ApoA1, non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG), TG/HDL-C, and TC/HDL-C were measured or calculated. The remnant cholesterol (RC) levels were calculated. The average lipid parameters before study entry were calculated using data from 2002 to 2010. The participants were divided into quartiles (Q) according to the parameter values. Cox proportional hazard modeling, adjusted for confounding factors, compared the CAC risk of the highest quartile to the lowest quartile.
Results:
Among 29,278 participants (mean age, 39.19±5.21; men, 88.27%), 2,779 developed CAC ＞0. The highest quartile of ApoB showed a numerically strong association with CAC risk, compared with the lowest quartile of ApoB (Q1: reference; Q2: HR,1.41, 95% CI,1.25-1.59; Q3: HR,1.97, 95% CI,1.75-2.21; Q4: HR,2.72, 95% CI,2.41-3.07). RC showed a modest association with CAC risk (Q1: reference; Q2: HR,1.13, 95% CI,0.99-1.28; Q3: HR,1.3, 95% CI,1.15-1.47; Q4: HR,1.7, 95% CI,1.51-1.91). The strength of the association was comparable between the parameters at baseline and the average lipid parameters over time.
Conclusions:
A high ApoB level showed a strong association with CAC risk compared with the lowest ApoB quartile. The baseline lipid parameters can predict CAC development as effectively as the average of multiple measurements can.
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