Study reveals coronary atherosclerosis prevalent even in low-risk adults with normal cholesterol levels

In a recent study published in the journal JACC Advances, researchers examined the presence of coronary atherosclerosis using coronary computed tomography angiography (CCTA) in asymptomatic adults without traditional risk factors based on their serum levels of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B (apoB). They found that coronary atherosclerosis is common, and the prevalence increases with increasing levels of atherogenic lipoproteins, even in low-risk adults without traditional risk factors.

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality worldwide, primarily due to coronary atherosclerosis, which begins early and progresses over time. Elevated LDL-C is a major contributor to ASCVD, and lowering LDL-C levels is essential for prevention. Traditionally, LDL-C levels of ≥160 mg/dL were considered elevated, while levels <100 mg/dL were deemed optimal. However, these thresholds may still be inadequate for preventing atherosclerosis or ASCVD.

Data for the present study included a total of 1,033 participants aged 40–65 years. All participants were free of clinically symptomatic cardiovascular disease and were not undergoing lipid-lowering therapy. A subgroup of 184 participants with optimal risk factors was also identified. Individuals with high-risk conditions such as obesity, high creatinine levels, asthma, cancer, or pregnancy were excluded from the study. The median age of the participants was 51 years. Data on demographics, clinical history, and coronary computed tomography angiography (CCTA) imaging were collected. Coronary atherosclerosis was diagnosed using the Agatson method and classified according to the American Heart Association guidelines.

The study cohort had median serum LDL-C, non-HDL-C, and apoB levels of 125, 144, and 94 mg/dL, respectively. A majority of the participants had a lower predicted 10-year ASCVD risk, with over 86% having <5% risk. Men showed a higher body mass index, atherogenic lipoprotein levels, and ASCVD risk compared to women.

In conclusion, the study suggests that among asymptomatic, apparently healthy, middle-aged adults without traditional ASCVD risk factors, coronary atherosclerosis is common even at serum cholesterol levels considered to be normal. The condition's prevalence increases with higher LDL-C, non-HDL-C, and apoB. Despite this population's relatively infrequent high-risk plaque features, healthcare professionals should consider lowering serum atherogenic lipoproteins through diet, lifestyle changes, or medication to potentially prevent or delay coronary atherosclerosis and improve their health outcomes.

References: Serum Lipoproteins are Associated with Coronary Atherosclerosis in Asymptomatic U.S. Adults Without Traditional Risk Factors. Faridi, K. et al., JACC Advances, 7_Part_1 (2024), DOI:10.1016/j.jacadv.2024.101049,https://www.jacc.org/doi/10.1016/j.jacadv.2024.101049