Performance of Novel Low-density Lipoprotein-cholesterol Calculation Methods in Predicting Clinical and Subclinical Atherosclerotic Cardiovascular Disease Risk: The Multi-Ethnic Study of Atherosclerosis

Background And Aims: This study examined the performance of two novel low-density lipoprotein-cholesterol (LDL-C) calculations, LDL and LDL, on predicting atherosclerotic cardiovascular diseases (ASCVD) risk compared to traditional LDL according to the 2018 American Heart Association/American College of Cardiology (AHA/ACC) primary prevention guidelines.

Methods: A total of 6701 randomly recruited Multi-Ethnic Study of Atherosclerosis (MESA) participants free of ASCVD at baseline were followed for ASCVD during a median of 13.9 years and for subclinical ASCVD-coronary artery calcium (CAC) during a median of 12.5 years. Prevalence of borderline high triglyceride (≥1.7 mmol/L) was 15.2% and was at 13.5% for high triglyceride (≥2.3 mmol/L).

Results: Applying the criteria of LDL-C<1.8 mmol/L in 40-75 year olds without diabetes mellitus to be exempt from risk discussion, LDL and LDL classified less individuals in this category than LDL (p < 0.001), both had 20 individuals with ASCVD, versus 22 by LDL. Positive CAC in the discussion-exempt group were over 38% higher (p < 0.001) when classified by LDL than by LDL or LDL. Individuals with LDL-C≥4.9 mmol/L are recommended to high-intensity statin therapy by the AHA/ACC guidelines. The LDL≥4.9 mmol/L group had 20 ASCVD events, versus 21 in LDL and 22 in LDL group.

Conclusions: In a multi-ethnic USA population, LDL and LDL did not over- or under-estimate ASCVD risk compared to LDL in primary prevention according to AHA/ACC guidelines, while LDL under-estimated subclinical ASCVD risk in the low-risk population. These findings support the replacement of LDL by LDL or LDL for lipid screen in the general population.