In patients with chronic coronary syndromes, LDL-C <70 mg/dL and diabetes/prediabetes were independently linked to higher CTA CAD risk scores, with OR 3.28 and 5.57 respectively.
Are very low LDL-C levels and impaired glucose metabolism associated with higher CTA-derived CAD risk scores in patients with chronic coronary syndromes?
In patients with chronic coronary syndromes, very low LDL-C levels and impaired glucose metabolism are independently associated with higher CTA-derived CAD risk scores, highlighting a potential framework for understanding residual risk.
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Abstract Background Atherosclerotic coronary artery disease (CAD) is still the major cause of cardiovascular disease (CVD) mortality and morbidity. In patients with chronic coronary syndromes (CCS) presence and extent of CAD, assessed by computerized tomography angiography (CTA), stratify risk and guide management including lipid lowering treatment with very low low-density lipoprotein cholesterol (LDL-C) targets to improve outcome. Observational and Mendelian randomization studies in general populations associated very low LDL-C with increased prevalence of diabetes and pre-diabetes. It is not fully known whether this association stands also in patients with CCS and whether it impacts on CAD residual risk (RR) persisting despite current treatment. Purpose We aimed to assess the association of very low LDL-C levels with prevalence of diabetes (fasting glucose ≥126 mg/dL or known diabetes under treatment) or pre-diabetes (fasting glucose 100–125 mg/dL) and with CTA defined CAD risk scores in patients with CCS. Methods Among the 561 patients with CCS enrolled in the HURRICANE study (Health improvement by Understanding RR In CAd and NEw targets for treatment), 479 patients (65.2±10.5 yrs, 69.7% male) with high quality CTA and full clinical/biohumoral characterization were selected. CTA exams were analysed according to CAD-RADS2 classification and the Leiden Risk Score, incorporating stenosis severity, plaque location, extent, and composition, was computed. Higher CAD risk end-points were: 1) CAD-RADS2 3-5 and/or P3-4 scores; 2) Leiden score 20. In multivariate logistic regression models, LDL-C categories (70, 70-99,100-129, ≥130 mg/dL), diabetes or prediabetes were included together with age, gender and other risk factors. Results Diabetes or prediabetes were present in 20.7% and 28.0% of patients. The CAD-RADS2 and Leiden score end-points were present in 49.7% and in 11.5% of patients. At multivariable analysis, older age, male gender, lower LDL-C categories (70, 70-99) and diabetes or prediabetes were independently associated with CAD-RADS2 score end-point, after correction for other risk factors (Fig 1). The lowest LDL-C category (70) and diabetes/prediabetes were independently associated with the Leiden Score end-point OR (95% CI) 3.28 (1.02-10.57) and 5.57 (2.46-12.65), respectively. These associations remained consistent in the subgroups taking or not taking statins (40% of patients). Notably, the prevalence of diabetes and the Leiden score were increased in the two lower LDL-C categories (70, 70-99) in the whole population (Fig 2A) and in patients taking statins (Fig 2B) and in the lowest LDL-C category (70) in patients not taking statins (Fig 2C). Conclusions The present results firstly demonstrate an independent and strong association of impaired glucose metabolism with CTA derived CAD risk scores in patients with CCS and very low LDL-C levels with or without statin treatment suggesting a potential framework to understand RR.Predictors of high CAD-RADS2 risk score Diabetes, Leiden Score in LDL-C classes
Neglia et al. (Sat,) reported a other. In patients with chronic coronary syndromes, LDL-C <70 mg/dL and diabetes/prediabetes were independently linked to higher CTA CAD risk scores, with OR 3.28 and 5.57 respectively.