Sex-specific associations between total cholesterol and non-high-density lipoprotein cholesterol and the presence and extent of coronary artery calcifications

Aims Investigate sex-specific associations between total cholesterol, non-HDL cholesterol (non-HDL-C), and the burden of atherosclerosis assessed by coronary artery calcium (CAC) score. Methods and results A total of 10 049 participants (women: 958, men: 9091) aged 49-75 years, without known cardiovascular disease (CVD) or current use of lipid-lowering medication, were included from the Danish Risk Score study and the Danish Cardiovascular Screening Trial cohorts. Logistic regression models and zero-inflated negative binomial regression models were used to estimate odds ratio (OR), the incidence rate ratio (IRR), and 95% confidence intervals (CIs) for the association between total cholesterol, non-HDL-C, and CAC presence (CAC > 0) and extent. All analyses were adjusted for age, body mass index, diabetes, smoking, hypertension, and family history of CVD. The OR for presence of CAC and total cholesterol was 1.09 (95% CI: 0.94-1.27) in women and 1.26 (95% CI: 1.19-1.33) in men. The OR for presence of CAC and non-HDL-C was 1.12 (95% CI: 0.96-1.29) in women and 1.25 (95% CI: 1.18-1.33) in men. No significant association between increased total cholesterol and extent of CAC was found, regardless of sex (women: IRR: 0.99; 95% CI: 0.83-1.19; men: IRR: 1.04; 95% CI: 0.997-1.07). Non-HDL-C was significantly associated with extent of CAC in men (IRR: 1.04; 95% CI: 1.001-1.08) but not in women (IRR: 0.93; 95% CI: 0.78-1.12). Conclusion Total cholesterol was associated with presence of CAC, and non-HDL-Cs were associated with presence and extent of the CAC score in men. No association by total cholesterol or non-HDL-C was found among women. Lay summary In both men and women, high cholesterol increases the risk of having a heart attack. It is unclear whether the significance of high cholesterol is as serious in women as it is in men regarding the development of atherosclerosis. In this study, we investigated the relationship between cholesterol and atherosclerosis in 10 049 Danish men and women, respectively. Atherosclerosis was measured by cardiac computed tomography (CT) scans. We found that: center dot High total cholesterol and non-HDL-C were both associated with calcifications in men. center dot High total cholesterol and non-HDL-C were not associated with calcifications in women.