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

Investigate sex-specific associations between total cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C) and the burden of atherosclerosis assessed by coronary artery calcium (CAC) score. A total of 10,049 participants (women: 958, men: 9,091) 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 (CI) for the association between total cholesterol, non-HDL-C, and CAC presence (CAC > 0) and extent. All analyses were adjusted for age, BMI, 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). Total cholesterol was associated with presence of CAC and non-HDL-C were associated with presence and extent of the CAC score in men. No association by total cholesterol or non-HDL-C were found among women.