Relation of coronary artery calcium identified by electron beam tomography to serum lipoprotein levels and implications for treatment

This study was designed to determine whether the National Cholesterol Education Program (NCEP) lipid guidelines accurately identify subclinical atherosclerosis and whether low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels are related to the extent and prematurity of coronary artery disease (CAD) as determined by electron beam tomography (EBT). Out of personal concern for CAD risk, 930 consecutive asymptomatic subjects, without clinical CAD and on no lipid-lowering agents, underwent EBT. Calcium score and percentile were correlated with total cholesterol (TC), LDL-C, HDL-C, triglycerides, and demographic parameters. A calcium score of >0 (EBT+) was found in 55% of patients; 45% of patients had a 0 score (EBT−). Mean age (58.0 ± 10.5 vs 49.3 ± 9.7 years, p = 0.0001), TC (218 ± 39 vs 211 ± 41 mg/dl, p = 0.006), LDL-C (136 ± 36 vs 127 ± 27 mg/dl, p = 0.005), and TC/HDL-C (4.6 ± 1.4 vs 4.2 ± 1.5, p = 0.0001) were significantly higher and HDL-C (52.2 ± 17.6 vs 55.4 ± 19.3 mg/dl, p = 0.008) lower in the EBT+ compared with EBT− group. In the EBT+ group, 75.1% of subjects had LDL-C <160 mg/dl and would not be advised to use lipid-lowering medications according to NCEP guidelines. In subjects with LDL-C <160 mg/dl, 51.8% of subjects were EBT+, as were 46.1% of those with LDL-C <100 mg/dl. There were no significant differences in the calcium scores throughout the entire range of all lipid parameters; calcium percentiles were virtually identical within lipid value subgroups. We conclude that asymptomatic patients with EBT-defined subclinical atherosclerosis are not reliably identified by NCEP guidelines, and TC, LDL-C, HDL-C, TC/HDL-C, and triglyceride levels do not correlate with either the extent or prematurity of calcified plaque burden.