The following is the summary of “Coronary Artery Calcium Scoring for Risk Assessment in Patients With Severe Hypercholesterolemia” published in the December 2022 issue of American Journal of Cardiovascular Disease by Dong, et al.

Clinical guidelines from the American College of Cardiology and the American Heart Association state that individuals with severe hypercholesterolemia (low-density lipoprotein cholesterol [LDL-C] ≥190 mg/100 ml) should be treated with a high-intensity statin. But even among people with severe hypercholesterolemia, the risk of atherosclerotic cardiovascular disease (ASCVD) is variable, and coronary artery calcium (CAC) grading may help explain risk. To determine the effect of CAC on actual statin prescriptions, researchers studied people with severe hypercholesterolemia. 

Patients who participated in the Community Benefit of No-Charge Calcium Score Screening Program (CLARIFY) research (NCT04075122) between 2014 and 2020 and had at least one CAC score (LDL-C 190 mg/100 ml) were identified. Investigators analyzed the frequency of (CAC >0), identified risk factors for having (CAC >0), and determined the association between CAC and ASCVD (myocardial infarction, stroke, revascularization, death). There were 1,904 patients with severe hypercholesterolemia included (1.257 women, 57.8±  9.3 years old). The levels of low-density lipoprotein (LDL-C) varied from 190 to 524 mg/dl (the average was 215±.5 27). There were 864 patients (45.4%), and 1,561 (82%) had CAC 100. Among those with LDL-C levels below 250 mg/dL, 67 (36.6%) had CAC values of 0. There were significant correlations between (CAC>0) and age, being male, smoking, diabetes, systolic blood pressure, and obesity (P<0.001). 

In individuals with low levels of good cholesterol LDL-C ≥190 mg100 ml, CAC was linked with an increased risk for ASCVD events (CAC 100 vs. CAC 100, hazard ratio 3.57 [1.81 to 7.04], p <0.001). Statin use rose with increasing CAC category (P<0.001), suggesting a causal relationship between CAC score and statin consumption. A significant reduction in the incidence of ASCVD was seen in the subset of individuals with severe hypercholesterolemia who had (CAC=0). Cholesterol-lowering medication statins were linked to coronary artery disease risk reduction. Finally, CAC scoring may be useful for elucidating ASCVD risk in this diverse group of people with very high cholesterol levels.