Key result
Low HDL-C levels were an independent risk factor for subclinical coronary artery disease in patients undergoing carotid endarterectomy (adjusted OR 0.91; 95% CI 0.84-0.98; P=0.0099).
Why the study?
CAD is associated with carotid artery stenosis and is a perioperative risk factor for CEA, but the prevalence and risk factors of subclinical CAD in patients without known CAD undergoing CEA were unclear.
What is the prevalence and what are the risk factors for subclinical CAD in asymptomatic patients undergoing carotid endarterectomy?
Cohort (n=69)
No
What is the prevalence and what are the risk factors for subclinical CAD in asymptomatic patients undergoing carotid endarterectomy?
Subclinical CAD is present in approximately 17% of asymptomatic patients undergoing carotid endarterectomy, and is independently associated with lower HDL-C levels.
Answers are grounded in this paper and cite their sources.
Low HDL-C may flag subclinical CAD risk in CEA patients; hypothesis-generating for screening or HDL trials.
BACKGROUND: Coronary artery disease (CAD) is closely associated with carotid artery stenosis in the context of systemic arteriosclerosis, and it is a known perioperative risk factor for carotid endarterectomy (CEA). We aimed to evaluate the prevalence and risk factors of subclinical CAD in patients without known CAD undergoing CEA. METHODS: This was a single-center, retrospective, observational study conducted between January 2013 and December 2016. Among the patients scheduled for elective CEA, 69 with no medical history of CAD and no clinical symptoms (mean age, 76.4±7.8 years; 71.0% men) underwent coronary computed tomography (CT). Coronary angiography (CAG) and subsequent fractional flow reserve (FFR) estimation were performed if necessary. Subclinical CAD was defined as newly found significant coronary lesions after coronary CT screening. Significant coronary lesions were defined as lesions that showed total or subtotal occlusion on coronary CT, had ≥75% stenosis on CAG, or had FFR≤0.80 in major coronary arteries. RESULTS: The prevalence of subclinical CAD was 17.4% (12 of 69 patients). Among the patient characteristics assessed, only high-density lipoprotein cholesterol (HDL-C) levels were significantly different between patients with and those without subclinical CAD (45.8±10.1 vs. 59.7±16.7 mg/dL, P=0.0072). A multivariate analysis revealed that low HDL-C levels were independent risk factors for subclinical CAD after adjusting for possible confounders (adjusted odds ratio: 0.91, 95% confidence interval: 0.84-0.98, P=0.0099). CONCLUSIONS: Subclinical CAD is a common finding and is associated with low HDL-C in patients without known CAD undergoing CEA.
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Nakajima et al. (2019) conducted a cohort in Subclinical coronary artery disease in patients undergoing carotid endarterectomy (n=69). HDL-C levels was evaluated on Subclinical coronary artery disease (adjusted OR 0.91, 95% CI 0.84-0.98, p=0.0099). Low HDL-C levels were an independent risk factor for subclinical coronary artery disease in patients undergoing carotid endarterectomy (adjusted OR 0.91; 95% CI 0.84-0.98; P=0.0099).
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