title: Relation of Fasting Triglyceride-Rich Lipoprotein Cholesterol to Coronary Artery Calcium Score (from the ELSA-Brasil Study).
abstract: Although low-density lipoprotein cholesterol (LDL-C) is widely accepted as the principal lipid fraction associated with atherosclerosis, emerging evidence suggests a causal relation between lifelong elevations in triglyceride-rich lipoprotein cholesterol (TRL-C) and cardiovascular disease (CVD) in genetic studies. To provide further evidence for the potential relevance of TRL-C and atherosclerosis, we have evaluated the relation between TRL-C and coronary artery calcium (CAC) score. We included 3,845 subjects (49.9 ± 8.4 years, 54% women) who had no history of CVD, were not using lipid-lowering medications, and underwent CAC evaluation. We assessed the relation between increasing fasting TRL-C and the graded increase in CAC and to what extent TRL-C were independently associated with CAC over and above LDL-C using logistic regression models. Overall, 973 (25%) of the participants had a CAC >0 and 308 (8%) had a CAC >100. The median TRL-C level was 22 mg/dL (IQR 16 to 32). Subjects with CAC >0 had higher TRL-C levels than those with CAC = 0 (p <0.001). Similarly, subjects with CAC >0 had higher levels of LDL-C, non-high-density lipoprotein cholesterol, and lower high-density lipoprotein cholesterol (all p <0.001). After multivariate adjustment, log-transformed TRL-C remained associated with the presence and severity of CAC (all p <0.05). When TRL-C was added to models that contained demographic factors and conventional lipids, it significantly improved the model to predict the presence of CAC >0 (p = 0.01). In conclusion, in a large cohort of asymptomatic subjects, TRL-C was associated with subclinical atherosclerosis supporting a potentially causal role in CVD.
authors.affiliation: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil. Electronic address: msbittencourt@mail.harvard.edu.
authors.forename: Marcio S
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
authors.affiliation: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Henrique
authors.initials: H
authors.lastname: Staniak
authors.affiliation: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Sharovsky
authors.affiliation: Department of Primary Care and Public Health, Imperial College, London, United Kingdom.
authors.forename: Rao
authors.initials: R
authors.lastname: Kondapally
authors.affiliation: Department of Primary Care and Public Health, Imperial College, London, United Kingdom.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Vallejo-Vaz
authors.affiliation: Department of Primary Care and Public Health, Imperial College, London, United Kingdom.
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
authors.affiliation: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Isabela
authors.initials: I
authors.lastname: Bensenor
authors.affiliation: Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo School of Medicine, São Paulo, Brazil; University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Lotufo
mesh_terms: D000328:Adult; D001938:Brazil; D002097:C-Reactive Protein / Q000378:metabolism; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging; D005215:Fasting; D005260:Female; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D014057:Tomography, X-Ray Computed; D014280:Triglycerides / Q000097:blood*; D061205:Vascular Calcification / Q000097:blood* / Q000000981:diagnostic imaging
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D008074:Lipoproteins; D014280:Triglycerides; C030104:lipoprotein cholesterol; C030087:lipoprotein triglyceride; D002097:C-Reactive Protein; D002784:Cholesterol