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Relation of
coronary artery calcium identified by Electron Beam Tomography to serum
lipoprotein levels and implications for treatment.
Hecht
HS., Superko HR., Smith LK, McColgan BP.
Arizona
Heart Institute and Foundation, Phoenix, Arizona, USA.
Am
J Cardiol 2001 Feb 15;87(4): 406-412
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Objectives:
This
study was designed to determine whether the National Cholesterol Education
Program (NCEP) lipid guidelines accurately identify subclinical atherosclerosis
and whether low-density lipoprotein cholesterol (LDL-C) and high-density
lipoprotein cholesterol (HDL-C) levels are related to the extent and prematurity
of coronary artery disease (CAD) as determined by electron beam tomography (EBCT).
Method:
930 consecutive asymptomatic subjects, without clinical CAD
and on no lipid-lowering agents, underwent EBCT. Calcium score and
percentile were correlated with total cholesterol (TC), LDL-C, HDL-C,
triglycerides, and demographic parameters.
Results:
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n
= 930, asymptomatic patients
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EBCT
positive: Calcium > 0
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EBCT
negative: Calcium = 0
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P
value
|
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%
of patients
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55
%
|
45
%
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|
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Mean
age
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58
+ 10.5
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49.3
+ 9.7
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P
= 0.0001
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Total
cholesterol, mg/dl
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218
+ 39
|
211
+ 41
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P
= 0.006
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LDL
cholesterol, mg/dl
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136
+ 36
|
127
+ 27
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P
= 0.005
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Total
cholesterol / HDL cholesterol
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4.6
+ 1.4
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4.2
+ 1.5
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P
= 0.0001
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HDL
cholesterol, mg/dl
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52.2
+ 17.6
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55.4
+ 19.3
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P
= 0.008
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In
the EBCT+ group, 75.1% of subjects had LDL-C <160 mg/dl and would not be
advised to use lipid-lowering medications according to NCEP guidelines.
In
subjects with LDL-C <160 mg/dl, 51.8% of subjects were EBCT+, as
were 46.1% of those with LDL-C <100 mg/dl.
There
were no significant differences in the calcium scores throughout the entire
range of all lipid parameters; calcium percentiles were virtually identical
within lipid value subgroups.
Conclusion:
We
conclude that asymptomatic patients with EBCT-defined subclinical atherosclerosis
are not reliably identified by NCEP guidelines, and TC, LDL-C, HDL-C, TC/HDL-C,
and triglyceride levels do not correlate with either the extent or prematurity
of calcified plaque burden.
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