Significance of serum high-density lipoprotein cholesterol levels for diagnosis of coronary stenosis as determined by MDCT in patients with suspected coronary artery disease.
OBJECTIVE
Since we previously reported that lower levels of HDL-C may be most useful for predicting coronary artery disease (CAD) as assessed by multi-detector row computed tomography (MDCT), we sought to confirm, among the levels of LDL-C, HDL-C, non-HDL-C (total cholesterol minus HDL-C) and the ratio of LDL-C to HDL-C (LDL-C/HDL-C), which is most closely related to the presence of CAD.


RESULTS
The subjects consisted of 506 consecutive patients with suspected CAD who underwent MDCT with (+) or without (-) statin treatment. The levels of LDL-C in the statin (-) group were similar in categories I, II and III according to the Japan Atherosclerosis Society (JAS) Guidelines 2007, whereas the levels of HDL-C significantly decreased and LDL-C/HDL-C significantly increased as the category number increased. In the statin (-) group, the prevalence of CAD in categories I, II and III was 0, 16 and 33%, respectively (p=0.0018 for trend), in patients with good control of LDL-C levels according to the Guidelines. Multivariate logistic regression analysis was per-formed to examine the association between the presence of CAD and 11 possible factors. Age and HDL-C in the statin (-) group, and HDL-C in the statin (+) group were identified as significant independent variables that correlated with the presence of CAD. Receiver-operating characteristic curve analysis in the statin (-) and statin (+) groups showed a higher area under the curve for HDL-C than for LDL-C, non-HDL-C or LDL-C/HDL-C. In particular, the cut-off levels of HDL-C with the greatest sensitivity and specificity for the diagnosis of CAD in the statin (+) group were 55 mg/dL (sensitivity 0.816, specificity 0.510).


CONCLUSIONS
HDL-C levels are most closely associated with the presence of CAD. In particular, we need to perform coronary CT for suspected CAD patients with lower HDL-C levels under statin treatment.
Shiga
Yuhei
Y
Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.
Miura
Shin-ichiro
S
Mitsutake
Ryoko
R
Kawamura
Akira
A
Uehara
Yoshinari
Y
Saku
Keijiro
K
D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging; D023921:Coronary Stenosis / Q000097:blood* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL