Low-density lipoprotein-cholesterol subfractions as predictors for coronary artery calcium incidence and progression – The Brazilian longitudinal study of Adult Health (ELSA – Brasil)

BACKGROUND AND AIMS: Low-density lipoprotein-cholesterol (LDL-c) subfractions may play different roles in atherogenesis. Our objective was to evaluate the association between LDL-c subfractions and coronary artery calcium (CAC) incidence in individuals with a baseline CAC = 0 and CAC progression in those with CAC > 0 at baseline. METHODS: We include 2632 participants from the Brazilian Longitudinal Study of Adult Health cohort, all of whom underwent two repeated CAC score measurements and had LDL-c subfraction measurements. The LDL-c subfraction concentrations were measured by the vertical auto profile method and categorized as small dense LDL-c (sdLDL-c) and large buoyant LDL-c (lbLDL-c). We constructed logistic regression analyses to examine CAC incidence and CAC progression. Additionally, CAC progression was analyzed using linear regression analyses as continuous variables. RESULTS: At baseline, a total of 2066 individuals (47.2 years, 62.2% female) had CAC = 0 and 566 (53.63 years, 36.9% female) had CAC > 0. The mean interscan interval was (5.15 ± 2.37 years). We found a significant association between sdLDL-c and CAC incidence (OR, 1.29 [95% CI, 1.13-1.47]) but not for lbLDL-c (p = 0.28) after adjustment for confounders. We found no association of the sdLDL-c fraction with CAC progression in any of the analyses. However, lbLDL-c concentrations were inversely associated with CAC progression on both logistic and linear regression analyses (all p < 0.05). CONCLUSION: There is a positive association between incidence of CAC and sdLDL-c but not lbLDL-c. CAC progression was inversely associated with lbLDL-c but not with sdLDL-c.