Normal LDL-Cholesterol Levels Are Associated With Subclinical Atherosclerosis in the Absence of Risk Factors

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:70

Article

Fernandez-Friera, Leticia^1,2,3  Fuster, Valentin^1,4  Lopez-Melgar, Beatriz^1,2  Oliva, Belen¹  Garcia-Ruiz, Jose M.^1,3,5  Mendiguren, Jose⁶  Bueno, Hector^1,7,8  Pocock, Stuart^1,9  Ibanez, Borja^1,3,10  Fernandez-Ortiz, Antonio^1,3,11  Sanz, Javier^1,4 

[1] Ctr Nacl Invest Cardiovasc Carlos III, Madrid, Spain

[2] HM Hosp Ctr Integral Enfermedades Cardiovasc, Madrid, Spain

[3] CIBER Enfermedades CardioVasc, Madrid, Spain

[4] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[5] ISPA Hosp Univ Cent Asturias, Oviedo, Spain

[6] Banco Santander, Madrid, Spain

[7] I 12 Res Inst, Madrid, Spain

[8] Hosp Univ 12 Octubre, Madrid, Spain

[9] London Sch Hyg & Trop Med, London, England

[10] IIS Fdn Jimenez Diaz Univ Hosp, Madrid, Spain

[11] Hosp Clin San Carlos, Madrid, Spain

关键词: atherosclerosis;    LDL-cholesterol;    risk factors;   

DOI  :  10.1016/j.jacc.2017.10.024

来源: Elsevier

【 摘 要 】

BACKGROUND Absence of cardiovascular risk factors (CVRFs) is traditionally considered low risk for atherosclerosis; however, individuals without CVRFs, as currently defined, still have events. OBJECTIVES This study sought to identify predictors of subclinical atherosclerosis in CVRF-free individuals. METHODS Participants from the PESA (Progression of Early Subclinical Atherosclerosis) study (n 1/4 4,184) without conventional CVRFs were evaluated (n = 1,779; 45.0 +/- 4.1 years, 50.3% women). CVRF freedom was defined as no current smoking and untreated blood pressure <140/90 mm Hg, fasting glucose <126 mg/dl, total cholesterol <240 mg/dl, low-density lipoprotein cholesterol (LDL-C) <160 mg/dl, and high-density lipoprotein cholesterol >= 40 mg/dl. A subgroup with optimal CVRFs (n = 740) was also defined as having blood pressure <120/80 mm Hg, fasting glucose <100 mg/dl, glycosylated hemoglobin < 5.7%, and total cholesterol <200 mg/dl. We evaluated ultrasound-detected carotid, iliofemoral, and abdominal aortic plaques; coronary artery calcification; serum biomarkers; and lifestyle. Adjusted odds ratios (with 95% confidence interval) and ordinal logistic regression models were used. RESULTS Subclinical atherosclerosis (plaque or coronary artery calcification) was present in 49.7% of CVRF-free participants. Together with male sex and age, LDL-C was independently associated with atherosclerosis presence and extent, in both the CVRF-free and CVRF-optimal groups (odds ratio [x10 mg/dl]: 1.14 to 1.18; p < 0.01 for all). Atherosclerosis presence and extent was also associated in the CVRF-free group with glycosylated hemoglobin levels. CONCLUSIONS Many CVRF-free middle-aged individuals have atherosclerosis. LDL-C, even at levels currently considered normal, is independently associated with the presence and extent of early systemic atherosclerosis in the absence of major CVRFs. These findings support more effective LDL-C lowering for primordial prevention, even in individuals conventionally considered at optimal risk. (Progression of Early Subclinical Atherosclerosis [PESA] Study; NCT01410318) (c) 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

【 授权许可】

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