Author + information
- Received May 29, 2009
- Revision received January 7, 2010
- Accepted January 11, 2010
- Published online September 21, 2010.
- Pathmaja Paramsothy, MD, MS⁎,⁎ (, )
- Robert H. Knopp, MD†,
- Alain G. Bertoni, MD‡,
- Roger S. Blumenthal, MD§,
- Bruce A. Wasserman, MD∥,
- Michael Y. Tsai, PhD¶,
- Tessa Rue, MS#,
- Nathan D. Wong, PhD†† and
- Susan R. Heckbert, MD, PhD⁎⁎
- ↵⁎Reprint requests and correspondence:
Dr. Pathmaja Paramsothy, University of Washington/Harborview Medical Center, Division of Cardiology, 325 Ninth Avenue, Box 359720, Seattle, Washington 98104
Objectives The purpose of this study was to determine the association of combinations of lipid parameters with subclinical atherosclerosis.
Background Carotid intima-media thickness (CIMT) and coronary artery calcium (CAC) are significantly associated with incident cardiovascular disease (CVD). The association between common dyslipidemias (combined hyperlipidemia, [simple] hypercholesterolemia, dyslipidemia of metabolic syndrome, isolated low high-density lipoprotein cholesterol, and isolated hypertriglyceridemia) compared with normolipemia, and CIMT and CAC has not been previously examined.
Methods The MESA (Multi-Ethnic Study of Atherosclerosis) participants were White, Chinese, African-American, or Hispanic adults without clinical CVD. Subjects with diabetes mellitus or who were receiving lipid-lowering therapy were excluded. Every participant was classified into only 1 of 6 groups defined by specific low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or triglyceride cut points. Multivariate linear and relative risk regressions evaluated the cross-sectional associations with CIMT and CAC after adjusting for CVD risk factors. Interactions with race, sex, and high-sensitivity C-reactive protein were evaluated for CIMT and CAC outcomes.
Results Among 4,792 participants, only those with combined hyperlipidemia and hypercholesterolemia demonstrated both increased common CIMT (combined hyperlipidemia 0.048 mm thicker, 95% confidence interval [CI]: 0.016 to 0.080 mm; hypercholesterolemia 0.048 mm thicker, 95% CI: 0.029 to 0.067 mm) and internal CIMT (combined hyperlipidemia 0.120 mm thicker, 95% CI: 0.032 to 0.208 mm; and hypercholesterolemia 0.161 mm thicker, 95% CI: 0.098 to 0.223 mm) as well as increased risk for prevalent CAC (combined hyperlipidemia relative risk: 1.22, 95% CI: 1.08 to 1.38; hypercholesterolemia relative risk: 1.22, 95% CI: 1.11 to 1.34) compared with normolipemia. The interactions between lipid parameters and race, sex, or high-sensitivity C-reactive protein were not significant for any outcomes.
Conclusions Combined hyperlipidemia and simple hypercholesterolemia were associated with increased CIMT and prevalent CAC in a relatively healthy multiethnic population.
Continuing Medical Education (CME) is available for this article.
Dr. Knopp is deceased. This research was supported by contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95167 from the National Heart, Lung, and Blood Institute. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. Dr. Paramsothy is funded by grant no. 1KL2RR025015-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Dr. Paramsothy has received clinical research support (not supporting this project) from a Pfizer Preventive Cardiology Career Development Award. Dr. Knopp has received clinical trial support (none supporting this project) from Merck, AstraZeneca, Abbott Laboratories, Reliant, Takeda, and ISIS pharmaceuticals; and consultation fees from Abbot Laboratories and Upsher-Smith Laboratories.
- Received May 29, 2009.
- Revision received January 7, 2010.
- Accepted January 11, 2010.
- American College of Cardiology Foundation