Cardiovascular risk-enhancing factors and coronary artery calcium in South Asian American adults: The MASALA study

Coronary Artery Calcium Scoring in the Context of Widespread Lipoprotein(a) Testing: Clinical Considerations and Implications for Lipid-Lowering Therapies

PURPOSE OF REVIEW

This review evaluates the interplay between lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) for risk prediction and preventive therapy selection, with a special emphasis on scenarios where these measures are discordant, particularly in otherwise intermediate-risk, primary prevention patients.

RECENT FINDINGS

Observational studies and meta-analyses indicate a nuanced relationship between elevated Lp(a) levels and CAC burden and progression. Elevated Lp(a) is associated with an increased risk of CAC presence and progression; although, there is notable variability across studies. CAC predicts a similarly elevated risk in patients with low and high Lp(a). Joint elevation of Lp(a) and CAC is associated with a very high-risk patient subset. Elevated Lp(a) should prompt consideration of CAC testing for further risk stratification. In the future, we anticipate that an elevated CAC score could prompt consideration of testing for Lp(a) in select patients, as identifying or confirming elevated Lp(a) may help guide the use of dedicated Lp(a)-lowering therapies in very high-risk primary prevention populations.

Factors associated with diabetes mellitus and hypertension among adults in the northern rural area, Afghanistan

Afghanistan has an increasing trend of mortality due to non-communicable diseases but most studies were conducted in urban areas. This study aimed to assess the prevalence and factors associated with diabetes mellitus and hypertension in a rural area in Afghanistan. A cross-sectional study was conducted from September to October 2019 including 373 people who were 18-79 years old and lived in Andkhoy District, Afghanistan. Demographic and lifestyle data was collected by face-to-face interviews after informed consent was obtained. Height, body weight, blood pressure, waist circumference, and blood sugar level were measured by the data collection team. A logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The prevalence of diabetes mellitus and hypertension was 9.7% and 29.5%, respectively. Factors associated with diabetes mellitus were male gender (adjusted OR [AOR]=9.81, 95% CI: 2.48-38.90), family history of diabetes mellitus (AOR=3.84, 95% CI: 1.30-11.38), low physical activity (AOR=4.53, 95% CI: 1.13-18.26), and high waist circumference (AOR=7.93, 95% CI: 2.40-26.20). Snuff users were negatively associated with diabetes mellitus (AOR=0.18, 95% CI: 0.04-0.75). Factors associated with hypertension were the age group of 40-59 years (AOR=4.22, 95% CI: 1.99-8.95) and 60-79 years (AOR=19.83, 95% CI: 7.19-54.71) compared to 18-39 years, family history of hypertension (AOR=2.17, 95% CI: 1.15-4.10), and palaw intake of 3 times per week or more (AOR=1.86, 95% CI: 1.03-3.38). Lifestyle interventions for increasing physical activity should be introduced and health education about snuff usage and salt intake should be promoted in communities in Afghanistan.

The association of lipoprotein (a) with coronary artery calcification: A systematic review and meta-analysis

BACKGROUND AND AIMS

Coronary artery calcification (CAC) is a crucial pathophysiological characteristic of atherosclerosis. The association between lipoprotein (a) [Lp(a)] and CAC is inconsistent. We aimed to assess the relationship between Lp(a) and CAC by exploring the association between elevated Lp(a) and CAC prevalence, the relationship between Lp(a) level and CAC prevalence, and the correlation between elevated Lp(a) and CAC progression.

METHODS

We searched the PubMed, Web of Science, and EMBASE databases up to November 01, 2023. Studies exploring the association between serum Lp(a) and CAC (quantified using the Agatston score) were included. Association between Lp(a) level or elevated Lp(a) (higher than the cutoff values of 30 mg/dL, 50 mg/dL, or the highest quartile ranging from 33 to 38.64 mg/dL) and prevalence [CAC score >0 or >100, log (CAC score+1) >0] or progression (an increase in CAC score >0 or ≥100) of CAC were analysed. Odds ratios and 95% confidence intervals were calculated using a random-effects model.

RESULTS

40,073 individuals from 17 studies were included. Elevated Lp(a) was associated with a higher prevalence of CAC (OR, 1.31; 95% CI, 1.06 to 1.61; p = 0.01). As a continuous variable, Lp(a) level was positively correlated with the prevalence of CAC (OR, 1.05; 95% CI, 1.02 to 1.08; p = 0.003). Furthermore, elevated Lp(a) was associated with greater CAC progression (OR, 1.54; 95% CI, 1.23 to 1.92; p = 0.0002).

CONCLUSIONS

This meta-analysis suggested that Lp(a) is associated with prevalence and progression of CAC. Further studies are required to explore whether Lp(a)-lowering therapy could prevent or inhibit CAC, ultimately reducing coronary artery disease risk.