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Published in: Current Atherosclerosis Reports 6/2024

25-04-2024 | Arterial Occlusive Disease | Review

Subclinical Atherosclerosis to Guide Treatment in Dyslipidemia and Diabetes Mellitus

Authors: Reed Mszar, Miriam E. Katz, Gowtham R. Grandhi, Albert D. Osei, Antonio Gallo, Michael J. Blaha

Published in: Current Atherosclerosis Reports | Issue 6/2024

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Abstract

Purpose of Review

Dyslipidemia and type 2 diabetes mellitus are two common conditions that are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). In this review, we aimed to provide an in-depth and contemporary review of non-invasive approaches to assess subclinical atherosclerotic burden, predict cardiovascular risk, and guide appropriate treatment strategies. We focused this paper on two main imaging modalities: coronary artery calcium (CAC) score and computed tomography coronary angiography.

Recent Findings

Recent longitudinal studies have provided stronger evidence on the relationship between increased CAC, thoracic aorta calcification, and risk of cardiovascular events among those with primary hypercholesterolemia, highlighting the beneficial role of statin therapy. Interestingly, resilient profiles of individuals not exhibiting atherosclerosis despite dyslipidemia have been described. Non-conventional markers of dyslipidemia have also been associated with increased subclinical atherosclerosis presence and burden, highlighting the contribution of apolipoprotein B-100 (apoB)-rich lipoprotein particles, such as remnant cholesterol and lipoprotein(a), to the residual risk of individuals on-target for low-density lipoprotein cholesterol (LDL-C) goals. Regarding type 2 diabetes mellitus, variability in atherosclerotic burden has also been found, and CAC testing has shown significant predictive value in stratifying cardiovascular risk.

Summary

Non-invasive assessment of subclinical atherosclerosis can help reveal the continuum of ASCVD risk in those with dyslipidemia and diabetes mellitus and can inform personalized strategies for cardiovascular disease prevention in the primary prevention setting.
Literature
3.
go back to reference Tönnies T, Brinks R, Isom S, Dabelea D, Divers J, Mayer-Davis EJ, Lawrence JM, Pihoker C, Dolan L, Liese AD, Saydah SH, D'Agostino RB, Hoyer A, Imperatore G. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2060: the SEARCH for diabetes in youth study. Diabetes Care. 2023;46(2):313–20.CrossRefPubMed Tönnies T, Brinks R, Isom S, Dabelea D, Divers J, Mayer-Davis EJ, Lawrence JM, Pihoker C, Dolan L, Liese AD, Saydah SH, D'Agostino RB, Hoyer A, Imperatore G. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2060: the SEARCH for diabetes in youth study. Diabetes Care. 2023;46(2):313–20.CrossRefPubMed
8.
go back to reference Aggarwal R, Yeh RW, Joynt Maddox KE, Wadhera RK. Cardiovascular risk factor prevalence, treatment, and control in US adults aged 20 to 44 years, 2009 to March 2020. JAMA. 2023;329(11):899–909.CrossRefPubMedPubMedCentral Aggarwal R, Yeh RW, Joynt Maddox KE, Wadhera RK. Cardiovascular risk factor prevalence, treatment, and control in US adults aged 20 to 44 years, 2009 to March 2020. JAMA. 2023;329(11):899–909.CrossRefPubMedPubMedCentral
14.
go back to reference •• Orringer CE, Blaha MJ, Blankstein R, et al. The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. J Clin Lipidol. 2021;15(1):33–60. https://doi.org/10.1016/j.jacl.2020.12.005. This scientific statement provides key information and recommendations on the use of CAC scoring in clinical practice for specific subgroups of individuals including those with severe hypercholesterolemia and diabetes mellitus.CrossRefPubMed •• Orringer CE, Blaha MJ, Blankstein R, et al. The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction. J Clin Lipidol. 2021;15(1):33–60. https://​doi.​org/​10.​1016/​j.​jacl.​2020.​12.​005. This scientific statement provides key information and recommendations on the use of CAC scoring in clinical practice for specific subgroups of individuals including those with severe hypercholesterolemia and diabetes mellitus.CrossRefPubMed
15.
18.
go back to reference Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. ACC Expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022;80(14):1366–418. https://doi.org/10.1016/j.jacc.2022.07.006.CrossRefPubMed Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. ACC Expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022;80(14):1366–418. https://​doi.​org/​10.​1016/​j.​jacc.​2022.​07.​006.CrossRefPubMed
33•.
go back to reference . Tada H, Kojima N, Yamagami K, et al. Coronary artery calcium among patients with heterozygous familial hypercholesterolaemia. Eur Heart J Open. 2023;3(3):oead046. https://doi.org/10.1093/ehjopen/oead046. This study provided further evidence that CAC is an independent predictor of CVD events among individuals with heterozygous FH and, as a result, leads to significant improvements in risk stratification.CrossRefPubMedPubMedCentral . Tada H, Kojima N, Yamagami K, et al. Coronary artery calcium among patients with heterozygous familial hypercholesterolaemia. Eur Heart J Open. 2023;3(3):oead046. https://​doi.​org/​10.​1093/​ehjopen/​oead046. This study provided further evidence that CAC is an independent predictor of CVD events among individuals with heterozygous FH and, as a result, leads to significant improvements in risk stratification.CrossRefPubMedPubMedCentral
43.
go back to reference Santos RD, Rumberger JA, Budoff MJ, Shaw LJ, Orakzai SH, Berman D, Raggi P, Blumenthal RS, Nasir K. Thoracic aorta calcification detected by electron beam tomography predicts all-cause mortality. Atherosclerosis. 2010;209(1):131–5.CrossRefPubMed Santos RD, Rumberger JA, Budoff MJ, Shaw LJ, Orakzai SH, Berman D, Raggi P, Blumenthal RS, Nasir K. Thoracic aorta calcification detected by electron beam tomography predicts all-cause mortality. Atherosclerosis. 2010;209(1):131–5.CrossRefPubMed
50.
go back to reference Erqou S, Kaptoge S, Perry PL, et al. Emerging risk factors collaboration. lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 2009;302(4):412–23.CrossRefPubMed Erqou S, Kaptoge S, Perry PL, et al. Emerging risk factors collaboration. lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 2009;302(4):412–23.CrossRefPubMed
56.
go back to reference Erbel R, Lehmann N, Churzidse S, Möhlenkamp S, Moebus S, Mahabadi AA, Schmermund A, Stang A, Dragano N, Grönemeyer D, Seibel R, Kälsch H, Bauer M, Bröcker-Preuss M, Mann K, Jöckel KH, Heinz Nixdorf Recall Study Investigators. Gender-specific association of coronary artery calcium and lipoprotein parameters: the Heinz Nixdorf Recall Study. Atherosclerosis. 2013 Aug;229(2):531–40.CrossRefPubMed Erbel R, Lehmann N, Churzidse S, Möhlenkamp S, Moebus S, Mahabadi AA, Schmermund A, Stang A, Dragano N, Grönemeyer D, Seibel R, Kälsch H, Bauer M, Bröcker-Preuss M, Mann K, Jöckel KH, Heinz Nixdorf Recall Study Investigators. Gender-specific association of coronary artery calcium and lipoprotein parameters: the Heinz Nixdorf Recall Study. Atherosclerosis. 2013 Aug;229(2):531–40.CrossRefPubMed
57•.
go back to reference . Mehta A, Vasquez N, Ayers CR, et al. Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk. J Am Coll Cardiol. 2022;79(8):757–68. https://doi.org/10.1016/j.jacc.2021.11.058. Findings from this study showed that Lp(a) and CAC are independently associated with ASCVD risk, and that individuals with both elevated Lp(a) and high CAC scores are at the highest risk.CrossRefPubMedPubMedCentral . Mehta A, Vasquez N, Ayers CR, et al. Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk. J Am Coll Cardiol. 2022;79(8):757–68. https://​doi.​org/​10.​1016/​j.​jacc.​2021.​11.​058. Findings from this study showed that Lp(a) and CAC are independently associated with ASCVD risk, and that individuals with both elevated Lp(a) and high CAC scores are at the highest risk.CrossRefPubMedPubMedCentral
86•.
go back to reference . Patel KV, Budoff MJ, Valero-Elizondo J, et al. Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida. Circ Cardiovasc Imaging. 2023;16(10):e015314. https://doi.org/10.1161/CIRCIMAGING.123.015314. This study found that, among those without established CAD, worse glycemic status was associated with a greater presence and burden of coronary plaque, high-risk plaque features, and significant stenosis.CrossRefPubMed . Patel KV, Budoff MJ, Valero-Elizondo J, et al. Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida. Circ Cardiovasc Imaging. 2023;16(10):e015314. https://​doi.​org/​10.​1161/​CIRCIMAGING.​123.​015314. This study found that, among those without established CAD, worse glycemic status was associated with a greater presence and burden of coronary plaque, high-risk plaque features, and significant stenosis.CrossRefPubMed
89•.
go back to reference . Cainzos-Achirica M, Patel KV, Quispe R, et al. Coronary Artery Calcium for the Allocation of GLP-1RA for Primary Prevention of Atherosclerotic Cardiovascular Disease. JACC Cardiovasc Imaging. 2021;14(7):1470–2. https://doi.org/10.1016/j.jcmg.2020.12.024. The clinical implications from this study include that CAC may aid in identifying individuals who could benefit the most from novel ASCVD risk-reduction therapies in DM such GLP-1RA.CrossRefPubMed . Cainzos-Achirica M, Patel KV, Quispe R, et al. Coronary Artery Calcium for the Allocation of GLP-1RA for Primary Prevention of Atherosclerotic Cardiovascular Disease. JACC Cardiovasc Imaging. 2021;14(7):1470–2. https://​doi.​org/​10.​1016/​j.​jcmg.​2020.​12.​024. The clinical implications from this study include that CAC may aid in identifying individuals who could benefit the most from novel ASCVD risk-reduction therapies in DM such GLP-1RA.CrossRefPubMed
Metadata
Title
Subclinical Atherosclerosis to Guide Treatment in Dyslipidemia and Diabetes Mellitus
Authors
Reed Mszar
Miriam E. Katz
Gowtham R. Grandhi
Albert D. Osei
Antonio Gallo
Michael J. Blaha
Publication date
25-04-2024
Publisher
Springer US
Published in
Current Atherosclerosis Reports / Issue 6/2024
Print ISSN: 1523-3804
Electronic ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-024-01202-w
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