Alcohol Drinking May Modify the Association Between HDL-Cholesterol and Coronary Calcium Score in an Older Population

Objective: The associations between lipids and Coronary Calcium Score (CAC score) remain controversial. We aimed to investigate if high-density lipoprotein cholesterol (HDL-C) is correlated with Coronary Calcium Score among older adults. Design and method: A total of 819 older aged more than 55 years old (Men: 378 and Women: 441) without coronary sent from the Healthy Aging Longitudinal Study in Taiwan were evaluated the Coronary Calcium Score by Low-Dose CT Scan in 2023. The metabolic features were measured at baseline (2nd wave 2014∼2019). CAC score was calculated by the Agatston score formula by an FDA-approved automated AI program (AView, Coreline) and modified by an experienced cardiac CT technologist if necessary. Linear and logistic regression were used to investigate the association between HDL-cholesterol and CAC score. Results: The median [Q1 and Q3] of CAC score was 122.6 [23.2 and 392.7]. The proportion of all older adults was 20.15% (n=165) for CAC Score less than ten, 55.31% (n=453) for CAC score between 11 and 400, and 24.5% for CAC score more than 400. HDL-Cholesterol (age-sex adjusted R [adj-R]=-0.208, p<.0001) and triglycerides (adj-R=0.122, p<.0001) were significantly associated with log-CAC, but LDL-cholesterol (adj-R=-0.005, p=0.8915) and total cholesterol(adj-R=-0.054, p=0.1237) did not. All blood pressure measures, body mass index, and waist circumference were significantly positively associated with log-CAC. Older age, male gender, elevated systolic blood pressure, higher HBA1C, and lower HDL-C were independently associated with CAC. Furthermore, HDL-C was significantly associated with log-CAC Score in those with alcohol drinking habits (standardized beta [STB] = -0.207, p=0.003), but not in those without alcohol drinking habits (STB=-0.05, p=0.2717) (p-value for interaction=0.016). The odds ratios of low HDL-cholesterol (<40 for men and <50 mg/dL for women) at baseline for higher CAC (<10, 11∼400, 400+) were 1.91 (95% confidence intervals: 1.10∼3.31) and 1.26 (0.85∼1.85) for those with and without alcohol drinking habits, respectively. Conclusions: Lower HDL-cholesterol was associated with higher future CAC scores among older adults in this retrospective design. Furthermore, this association could be altered by alcohol consumption.