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Rikhi R, Schaich CL, Hafzalla GW, Patel NA, Tannenbaum JE, German CA, Polonsky T, Tsai MY, Ahmad MI, Islam T, Chevli PA, Shapiro MD. Small Dense Low-Density Lipoprotein Cholesterol and Coronary Artery Calcification in the Multi-Ethnic Study of Atherosclerosis. Eur J Prev Cardiol 2024:zwae049. [PMID: 38323698 DOI: 10.1093/eurjpc/zwae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 02/08/2024]
Abstract
AIM Elevated small dense-LDL-cholesterol (sd-LDL-C) increases atherosclerotic cardiovascular disease (CVD) risk. Although coronary artery calcium (CAC) is widely used for predicting CVD events, few studies have examined the relationship between sd-LDL-C and CAC. METHODS This study included 4672 individuals with directly-measured baseline sd-LDL-C and CAC from the Multi-Ethnic Study of Atherosclerosis (mean [SD] age: 61.9 [10.4] years; 52.5% women; 47.3% with baseline CAC [mean score >0]). We used multivariable general linear models and restricted cubic splines with goodness of fit testing to evaluate the association of sd-LDL-C with the presence of CAC. Odds ratios (OR [95% CI]) were adjusted for demographics and cardiovascular risk factors, including estimated total LDL-C. RESULTS Higher quartiles of sd-LDL-C were associated with presence of CAC, even after accounting for total LDL-C. Compared to the lowest quartile of sd-LDL-C, participants in Quartiles 2, 3 and 4 had higher odds for the presence of baseline CAC (Quartile 2 OR: 1.24 [1.00, 1.53]; Quartile 3 OR: 1.51 [1.19, 1.93]; and Quartile 4 OR 1.59 [1.17, 2.16]). Splines suggested a quadratic curvilinear relationship of continuous sd-LDL-C with CAC after adjustment for demographics and CVD risk factors (quadratic vs. first-order sd-LDL-C terms likelihood ratio test: p=0.015), but not after accounting for total LDL-C (quadratic vs. first-order terms: p=0.156). CONCLUSIONS In a large, multi-ethnic sample without known CVD, higher sd-LDL-C was associated with the presence of CAC, above and beyond total LDL-C. Whether selective direct measurement of sd-LDL-C is indicated to refine cardiovascular risk assessment in primary prevention warrants further investigation.
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Affiliation(s)
- Rishi Rikhi
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christopher L Schaich
- Department of Surgery, Hypertension and Vascular Research Centre, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - George W Hafzalla
- Department of Internal Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - Nisha A Patel
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jordan E Tannenbaum
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Charles A German
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois, USA
| | - Tamar Polonsky
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Muhammad I Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Tareq Islam
- Department of Medicine, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA
| | - Parag A Chevli
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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