LDL Cholesterol Independently Associated With Subclinical Atherosclerosis

high risk cholesterol lab test
high risk cholesterol lab test
In an analysis of the PESA study, nearly 50% of patients without cardiovascular risk factors had subclinical atherosclerosis.

Assessment of low-density lipoprotein cholesterol (LDL-C) levels in individuals without significant cardiovascular risk factors can provide predictive value for the presence and extent of early systemic atherosclerosis, according to study findings published in the Journal of the American College of Cardiology.

Researchers performed an analysis on a subset of patients from the PESA (Progression of Early Subclinical Atherosclerosis; ClinicalTrials.gov identifier: NCT01410318) study (n=1779; mean age, 45.0±4.1 years) who were free of cardiovascular risk factors. Freedom from these risk factors was defined as untreated blood pressure <140/90 mm Hg, fasting glucose <126 mg/dL, LDL-C <160 mg/dL, high-density lipoprotein cholesterol ≥40 mg/dL, total cholesterol <240 mg/dL, and being tobacco-free at study entry. An additional subgroup of participants with optimal cardiovascular risk factors (n=740) was also included.

In participants free of cardiovascular risk factors, 49.7% had subclinical atherosclerosis consisting of plaque or coronary artery calcification, as assessed by 2-dimensional vascular ultrasound and noncontrast cardiac computed tomography. Independent associations were found between the presence and extent of atherosclerosis and male gender, age, and LDL-C level in participants who were free of risk factors and those with optimal risk factors (odds ratio [x 10 mg/dL]: 1.14-1.18; P <.01 for all). In participants without risk factors, the presence and extent of atherosclerosis was also associated with levels of glycosylated hemoglobin.

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The investigators did not assess for nonmodifiable cardiovascular risk factors, such as second-hand tobacco smoke exposure or air pollution, which may have limited the findings. In addition, the researchers did not account for dietary or lifestyle factors.

Overall, the findings from this study present potential “important implications for primordial prevention strategies and for establishing cutoff values to define lipid disorders” in patients free of standard cardiovascular risk factors as well as those individuals who are at risk for heart disease.


Fernández-Friera L, Fuster V, López-Melgar B, et al. Normal LDL-cholesterol levels are associated with subclinical atherosclerosis in the absence of risk factors. J Am Coll Cardiol. 2017;70(24):2979-2991.