A synergistic relationship of elevated low-density lipoprotein cholesterol levels and systolic blood pressure with coronary artery calcification.
We sought to evaluate this "response-to-injury" hypothesis of atherosclerosis by studying the interaction between systolic blood pressure (SBP) and LDL- cholesterol (LDL-C) in predicting the presence of coronary artery calcification (CAC) in asymptomatic men. We studied 526 men (46+/-7 years of age) referred for electron-beam tomography (EBT) exam. The prevalence of CAC was determined across LDL-C tertiles (low: <115 mg/dl; middle: 115-139 mg/dl; high: >or=140 mg/dl) within tertiles of SBP (low: <121 mmHg; middle: 121-130 mmHg; high: >or=131 mmHg). CAC was found in 220 (42%) men. There was no linear trend in the presence of CAC across LDL-C tertiles in the low (p=0.6 for trend) and middle (p=0.3 for trend) SBP tertile groups, respectively. In contrast, there was a significant trend for increasing CAC with increasing LDL-C (1st: 44%; 2nd: 49%; 3rd: 83%; p<0.0001 for trend) in the high SBP tertile group. In multivariate logistic analyses (adjusting for age, smoking, triglyceride levels, HDL-cholesterol levels, body mass index, and fasting glucose levels), the odds ratio for any CAC associated with increasing LDL-C was significantly higher in those with highest SBP levels, whereas no such relationship was observed among men with SBP in the lower two tertiles. An interaction term (LDL-C x SBP) incorporated in the multivariate analyses was statistically significant (p=0.038). The finding of an interaction between SBP and LDL-C relation to CAC in asymptomatic men support the response-to-injury model of atherogenesis.
Musunuru
Kiran
K
The Ciccarone Preventive Cardiology Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Nasir
Khurram
K
Pandey
Shivda
S
Campbell
Catherine C
CC
Carvalho
Jose A M
JA
Meneghello
Romeu
R
Budoff
Matthew J
MJ
Blumenthal
Roger S
RS
Santos
Raul D
RD
D000328:Adult; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood* / Q000378:metabolism; D003331:Coronary Vessels / Q000378:metabolism* / Q000473:pathology; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D013599:Systole; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D008078:Cholesterol, LDL