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Coronary Artery Calcium for Risk Stratification Among Persons With Very High HDL Cholesterol

Alexander C Razavi1,2, Anurag Mehta3, Nathan D Wong4

  • 1Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.

JACC. Advances
|September 16, 2024
PubMed

Insights

Very high HDL cholesterol increases mortality risk. Coronary artery calcium (CAC) measurement is a more robust predictor of mortality and atherosclerotic cardiovascular disease (ASCVD) than traditional risk factors in these individuals.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Biomarkers

Background:

  • Very high high-density lipoprotein (HDL) cholesterol levels are paradoxically linked to increased risks of mortality and atherosclerotic cardiovascular disease (ASCVD).
  • Clinical risk stratification for individuals with very high HDL cholesterol presents significant challenges due to this association.
  • Traditional risk factors may not adequately predict outcomes in this specific patient population.

Purpose of the Study:

  • To investigate the prevalence of coronary artery calcium (CAC) in individuals with very high HDL cholesterol.
  • To compare the predictive power of CAC versus traditional risk factors for all-cause mortality and ASCVD in this cohort.
  • To enhance risk assessment strategies for patients with elevated HDL cholesterol.

Main Methods:

  • Analysis of 446 participants with very high HDL cholesterol from the CAC Consortium, with a median follow-up of 10.7 years.
  • Cox proportional hazards regression was used to assess associations between CAC, traditional risk factors, and mortality.
  • Validation analyses were conducted using data from 119 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) to assess incident ASCVD.

Main Results:

  • Half of the participants (50%) had prevalent CAC, with a median score of 118.
  • Prevalent CAC was associated with a 3.6-fold higher risk of all-cause mortality and proved more robust than individual traditional risk factors.
  • In the validation cohort, prevalent CAC predicted both all-cause mortality and ASCVD, whereas traditional risk factors did not.

Conclusions:

  • Coronary artery calcium (CAC) measurement can significantly improve clinical risk assessment in individuals with very high HDL cholesterol.
  • CAC emerges as a superior predictor of adverse cardiovascular outcomes compared to traditional risk factors in this population.
  • Integrating CAC assessment may refine preventive strategies for patients at elevated cardiovascular risk due to high HDL cholesterol.
Abstract

Keywords:
HDL cholesterolcardiovascular diseasescoronary artery calciummortalityrisk assessment

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