Hypercholesterolemia Is the Only Risk Factor Consistently Associated with Coronary Calcification in Three European Countries—Euro CCAD Study

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Abstract
Background and Aim: Coronary calcification has been described as a manifestation of subclinical atherosclerosis. However, its predictors are not well established. The aim of this study was to evaluate the relationship between coronary artery calcium score (CACs) evaluated by multi-detector computed tomography (MDCT) and atherosclerotic cardiovascular disease (CVD) risk factors in symptomatic patients in three European countries. Method: We retrospectively analyzed 550 patients (age 62.7 ± 12 year, 47.5% females) who presented with atypical chest pain in Germany, Denmark, and Sweden. The demographic indices, CVD risk factors, and CACs were analyzed. The CV risk factors were classified as low (no risk factors), intermediate (1–2 risk factors), and high (≥3 risk factors). Patients were geographically classified into: Gr. I–German (n = 344), Gr. II–Danish (n = 84), and Gr. III–Swedish (n = 122) patients. Results: In the cohort as a whole, the mean CACs was 270.3 ± 72, and the intermediate risk was more prevalent than low and high-risk (p < 0.05 for all). Among the CVD risk profile, arterial hypertension (AH) was the most prevalent, followed by hypercholesterolemia, obesity, smoking, and diabetes (53, 38.2, 23.7, 17.6, and 10.5%; p < 0.05 for all). The German population was younger and had less CVD risk factors compared to the Danish and Swedish populations (p < 0.05, for all). CACSs adjusted to age and sex was lowest in Swedish patients, followed by German patients, and highest in Danish patients (p < 0.05). The CACs modestly correlated with age (rpb = 0.52, p < 0.001), sex (rpb = 0.48, p < 0.001), and extent of risk (rpb = 0.35, p = 0.001). On multivariate regression analysis, hypercholesterolemia β = 185.1 (63.11 to 307.1), the extent of risk adjusted for age and sex β 3.741 (2.566 to 4.916; p < 0.001), and AH, β = 142.6 (11.25 to 274.1; p = 0.03) independently correlated with CACs. Furthermore, hypercholesterolemia was the only risk factor, consistently associated with CACs across all three countries. Conclusions: In symptomatic European patients, hypercholesterolemia is the main player in coronary calcium formation.

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