Relation of Fasting Triglyceride-Rich Lipoprotein Cholesterol to Coronary Artery Calcium Score (from the ELSA-Brasil Study)

Am J Cardiol. 2017 May 1;119(9):1352-1358. doi: 10.1016/j.amjcard.2017.01.033. Epub 2017 Feb 10.


Although low-density lipoprotein cholesterol (LDL-C) is widely accepted as the principal lipid fraction associated with atherosclerosis, emerging evidence suggests a causal relation between lifelong elevations in triglyceride-rich lipoprotein cholesterol (TRL-C) and cardiovascular disease (CVD) in genetic studies. To provide further evidence for the potential relevance of TRL-C and atherosclerosis, we have evaluated the relation between TRL-C and coronary artery calcium (CAC) score. We included 3,845 subjects (49.9 ± 8.4 years, 54% women) who had no history of CVD, were not using lipid-lowering medications, and underwent CAC evaluation. We assessed the relation between increasing fasting TRL-C and the graded increase in CAC and to what extent TRL-C were independently associated with CAC over and above LDL-C using logistic regression models. Overall, 973 (25%) of the participants had a CAC >0 and 308 (8%) had a CAC >100. The median TRL-C level was 22 mg/dL (IQR 16 to 32). Subjects with CAC >0 had higher TRL-C levels than those with CAC = 0 (p <0.001). Similarly, subjects with CAC >0 had higher levels of LDL-C, non-high-density lipoprotein cholesterol, and lower high-density lipoprotein cholesterol (all p <0.001). After multivariate adjustment, log-transformed TRL-C remained associated with the presence and severity of CAC (all p <0.05). When TRL-C was added to models that contained demographic factors and conventional lipids, it significantly improved the model to predict the presence of CAC >0 (p = 0.01). In conclusion, in a large cohort of asymptomatic subjects, TRL-C was associated with subclinical atherosclerosis supporting a potentially causal role in CVD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brazil
  • C-Reactive Protein / metabolism
  • Cholesterol / blood*
  • Cholesterol, HDL / blood*
  • Cholesterol, LDL / blood*
  • Coronary Artery Disease / blood*
  • Coronary Artery Disease / diagnostic imaging
  • Fasting
  • Female
  • Humans
  • Lipoproteins / blood*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Tomography, X-Ray Computed
  • Triglycerides / blood*
  • Vascular Calcification / blood*
  • Vascular Calcification / diagnostic imaging


  • Cholesterol, HDL
  • Cholesterol, LDL
  • Lipoproteins
  • Triglycerides
  • lipoprotein cholesterol
  • lipoprotein triglyceride
  • C-Reactive Protein
  • Cholesterol