Association of Coronary Plaque With Low-Density Lipoprotein Cholesterol Levels and Rates of Cardiovascular Disease Events Among Symptomatic Adults

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Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Heart Scan Helps Find Low-Risk Patients Even With High Cholesterol

In a large cohort of symptomatic patients undergoing coronary CT angiography, those with high LDL-cholesterol (≥190 mg/dL) and no coronary plaque or calcium buildup had a low risk of cardiovascular events. This suggests that the presence of plaque, especially calcified plaque, is a better indicator of risk than high LDL-C alone in this population, and could be used to better target intensive treatment.

Possible Conflicts of Interest

Dr. Blaha reported receiving grants and personal fees from various pharmaceutical companies. Dr. Pareek reported serving on advisory boards and receiving speaker's fees from pharmaceutical companies. Dr. Nasir reported serving on advisory boards and receiving research support from pharmaceutical companies.

Identified Weaknesses

Short follow-up duration

The study only followed patients for a median of 4.2 years, which is a relatively short time frame for cardiovascular events. Longer follow-up is needed to see if the findings hold true over a longer period.

Symptomatic patient population

The study population consisted of symptomatic patients, so the findings may not apply to asymptomatic individuals.

Lack of noncalcified plaque quantification

Noncalcified plaque burden was not quantified, which could provide additional risk stratification.

Rating Explanation

This is a well-conducted study with a large sample size and robust findings. The results have important clinical implications for risk stratifying patients with high LDL-C. However, limitations such as the short follow-up period and focus on symptomatic patients warrant a slightly lower rating than 5.

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