Performance of novel low-density lipoprotein-cholesterol calculation methods in predicting clinical and subclinical atherosclerotic cardiovascular disease risk: The Multi-Ethnic Study of Atherosclerosis

Jing Cao; Alan T Remaley; Weihua Guan; Sridevi Devaraj; Michael Y Tsai

doi:10.1016/j.atherosclerosis.2021.04.018

Performance of novel low-density lipoprotein-cholesterol calculation methods in predicting clinical and subclinical atherosclerotic cardiovascular disease risk: The Multi-Ethnic Study of Atherosclerosis

Atherosclerosis. 2021 Jun:327:1-4. doi: 10.1016/j.atherosclerosis.2021.04.018. Epub 2021 May 8.

Authors

Jing Cao¹, Alan T Remaley², Weihua Guan³, Sridevi Devaraj⁴, Michael Y Tsai⁵

Affiliations

¹ Department of Pathology, University of Texas Southwestern Medical Center, USA.
² Division of Lipoprotein Metabolism, National Heart, Lung and Blood Institute, USA.
³ Division of Biostatistics, University of Minnesota School of Public Health, Twin Cities, USA.
⁴ Department of Pathology and Immunology, Baylor College of Medicine, USA; Department of Pathology, Texas Children's Hospital, USA.
⁵ Department of Pathology and Laboratory Medicine, University of Minnesota, Twin Cities, USA. Electronic address: tsaix001@umn.edu.

PMID: 34004482
DOI: 10.1016/j.atherosclerosis.2021.04.018

Abstract

Background and aims: This study examined the performance of two novel low-density lipoprotein-cholesterol (LDL-C) calculations, LDL_Martin and LDL_Sampson, on predicting atherosclerotic cardiovascular diseases (ASCVD) risk compared to traditional LDL_Friedewald according to the 2018 American Heart Association/American College of Cardiology (AHA/ACC) primary prevention guidelines.

Methods: A total of 6701 randomly recruited Multi-Ethnic Study of Atherosclerosis (MESA) participants free of ASCVD at baseline were followed for ASCVD during a median of 13.9 years and for subclinical ASCVD-coronary artery calcium (CAC) during a median of 12.5 years. Prevalence of borderline high triglyceride (≥1.7 mmol/L) was 15.2% and was at 13.5% for high triglyceride (≥2.3 mmol/L).

Results: Applying the criteria of LDL-C<1.8 mmol/L in 40-75 year olds without diabetes mellitus to be exempt from risk discussion, LDL_Martin and LDL_Sampson classified less individuals in this category than LDL_Friedewald (p < 0.001), both had 20 individuals with ASCVD, versus 22 by LDL_Friedewald. Positive CAC in the discussion-exempt group were over 38% higher (p < 0.001) when classified by LDL_Friedewald than by LDL_Martin or LDL_Sampson. Individuals with LDL-C≥4.9 mmol/L are recommended to high-intensity statin therapy by the AHA/ACC guidelines. The LDL_Friedewald≥4.9 mmol/L group had 20 ASCVD events, versus 21 in LDL_Martin and 22 in LDL_Sampson group.

Conclusions: In a multi-ethnic USA population, LDL_Martin and LDL_Sampson did not over- or under-estimate ASCVD risk compared to LDL_Friedewald in primary prevention according to AHA/ACC guidelines, while LDL_Friedewald under-estimated subclinical ASCVD risk in the low-risk population. These findings support the replacement of LDL_Friedewald by LDL_Martin or LDL_Sampson for lipid screen in the general population.

Keywords: Cardiovascular disease risk; LDL-C Calculation; Low-density lipoprotein cholesterol.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Atherosclerosis*
Cardiovascular Diseases*
Cholesterol, LDL
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Risk Assessment
Risk Factors
United States

Substances

Cholesterol, LDL
Hydroxymethylglutaryl-CoA Reductase Inhibitors