Association of blood lipids with coronary artery plaque among Saudi patients referred to computed tomography

Background Blood lipids are strong risk factors for the progression of atherosclerotic plaques. However, data on gender-specific associations are limited. Objectives To examine gender-specific associations of coronary plaque with blood lipids among a large sample of Saudi patients without CAD. Methods Retrospective cross-sectional study was conducted among adult patients referred to (64 multidetector spiral) computed tomography (CT) for standard indications at the Prince Sultan Cardiac Centre (Riyadh, Saudi Arabia) between July 2007 and December 2017. Those with pre-existing CAD were excluded. Plaques were determined based on quantification of coronary calcium and Coronary CT angiography. Results A total 2421 patients (1498 males and 923 females) were included. The prevalence of any plaque was 36.6% with higher burden in males than females (41.3% versus 28.9%, p < 0.001). Approximately 78.9% of all plaques were calcified. Blood lipids (mmol/L) were 4.75 +/- 1.14 for total cholesterol, 2.90 +/- 0.96 for LDL cholesterol, 1.20 +/- 0.36 for HDL cholesterol, and 1.64 +/- 1.09 for triglycerides. Males had significantly higher triglycerides and lower HDL cholesterol compared with females. In adjusted models in males and all patients, soft and/or calcified plaques were significantly associated with lower HDL cholesterol and higher triglycerides. In females, the only significant association was between soft plaques and higher triglycerides. Conclusions Middle-aged patients without clinical CAD in Saudi Arabia have a high burden of plaques, specially calcified ones. The findings may impact the use of lipid lowering mediations, by underscoring the importance of assessing the risk of CAD in patients without clinical CAD even in case of lack of coronary calcification.

Automated summary

The burden of plaques, especially calcified ones, is high in middle-aged Saudi patients without clinical CAD, with a higher prevalence in males. Abnormal blood lipids play an important role in plaque formation, highlighting the importance of assessing the risk of CAD in patients without clinical CAD.