Researchers find coronary atherosclerosis is prevalent in individuals who are seemingly at low risk for cardiovascular distress.
A new study published in the journal JACC Advances has challenged traditional predictive factors for heart disease by investigating the presence of coronary atherosclerosis, a condition where arteries become narrowed or blocked due to the fatty deposits, in individuals at low risk for cardiovascular issues. Using coronary computed tomography angiography (CCTA), the study revealed that, despite other factors that make these individuals seem low risk, the condition was surprisingly common.
Coronary atherosclerosis is a one of the predictive factors for atherosclerotic cardiovascular disease (ASCVD), specifically, is a leading cause of death globally. Typically, high LDL-C levels are recognized as a significant risk factor for ASCV. Traditionally, LDL-C levels below 100 mg/dL have been considered optimal, while levels above 160 mg/dL are high. Despite this, coronary atherosclerosis and ASCVD can still develop in individuals with LDL-C levels, the team found.
Non-HDL-C and apoB are also strong predictors of heart disease. However, the relationship between these lipoproteins and the development of coronary atherosclerosis in adults without clinical ASCVD or other risk factors remains poorly understood.
The study aimed to explore this relationship, analyzing data from the Miami Heart (MiHeart) study, involving 1,033 participants aged 40 to 65 years who were free from cardiovascular disease and were not on lipid-lowering therapy. A subgroup of 184 participants with optimal risk factors was also included. Participants with conditions like obesity, high creatinine levels, asthma, cancer, or pregnancy were excluded.
The median age of the participants was 51 years, with 42.1% identifying as non-Hispanic White, and 55% being female. The study collected detailed demographic and medical history information, as well as CCTA imaging results. Coronary atherosclerosis was assessed using the Agatson method and the American Heart Association (AHA) classification.
The study’s results revealed that the median serum levels for LDL-C, non-HDL-C, and apoB were 125 mg/dL, 144 mg/dL, and 94 mg/dL, respectively. Despite most participants having a predicted 10-year ASCVD risk of less than 5%, coronary plaque was detected in 35.9% of individuals without traditional risk factors. The prevalence of both coronary and calcified plaque increased in tandem with rising levels of LDL-C, non-HDL-C, and apoB.
Men had higher levels of atherogenic lipoproteins and ASCVD risk compared to women, and they also showed higher rates of coronary plaque and more high-risk plaque features. The study also found that the presence of coronary plaque increased with age in both sexes.
Among the subgroup with optimal risk factors, 21.2% had coronary plaque, though severe or high-risk plaque features were less common. Age and male sex were again the most critical predictors of coronary atherosclerosis, with higher levels of LDL-C, non-HDL-C, and apoB also linked to the presence of coronary plaque, albeit not at statistically significant levels in this smaller group.
The findings of this study challenge the conventional understanding of predictive factors for cardiovascular risk. Given the results, healthcare providers might need to reconsider the thresholds for initiating preventive measures, such as dietary changes, lifestyle modifications, or lipid-lowering therapies, even in low-risk populations. The ability to accurately predict the likelihood of heart disease developing given certain internal factors, as well as lifestyle choices, is key to initiating earl interventions and saving lives.
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Coronary atherosclerosis prevalent even in low-risk adults with normal cholesterol levels
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