
Low-density lipoprotein cholesterol (LDL-C) is an important causal risk factor for atherosclerotic cardiovascular disease (ASCVD). However, a sizable proportion of middle-aged individuals with elevated LDL-C levels have not developed coronary atherosclerosis as assessed by coronary artery calcification (CAC). Whether the presence of CAC modifies the association of LDL-C with ASCVD risk is unknown. This study evaluated the association of LDL-C with future ASCVD events in patients with and without CAC. Based on the study findings, LDL-C appears to be almost exclusively associated with ASCVD events over ≈5 years of follow-up in middle-aged individuals with versus without evidence of coronary atherosclerosis. This information is valuable for individualized risk assessment among middle-aged people with or without coronary atherosclerosis.
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