Abstract 4369545: Differential impact of aging on cardiovascular disease risk in male military service members

Higher coronary artery calcium (CAC) identifies individuals at increased atherosclerotic cardiovascular disease (ASCVD) risk. Whether it can also identify individuals likely to derive net benefit from aspirin therapy is unclear. To examine the association between CAC, bleeding, and ASCVD and explore the net estimated effect of aspirin at different CAC thresholds. Prospective population-based cohort study of Dallas Heart Study participants, free from ASCVD and not taking aspirin at baseline. Data were analyzed between February 1, 2020, and July 15, 2020. Coronary artery calcium score in the following categories: 0, 1-99, and 100 or higher. Major bleeding and ASCVD events were identified from International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. Meta-analysis-derived aspirin effect estimates were applied to observed ASCVD and bleeding rates to model the net effect of aspirin at different CAC thresholds. A total of 2191 participants (mean [SD], age 44 [9.1] years, 1247 women [57%], and 1039 black individuals [47%]) had 116 major bleeding and 123 ASCVD events over a median follow-up of 12.2 years. Higher CAC categories (CAC 1-99 and ≥100 vs CAC 0) were associated with both ASCVD and bleeding events (hazard ratio [HR], 1.6; 95% CI, 1.1-2.4; HR, 2.6; 95% CI, 1.5-4.3; HR, 4.8; 95% CI, 2.8-8.2; P < .001; HR, 5.3; 95% CI, 3.6-7.9; P < .001), but the association between CAC and bleeding was attenuated after multivariable adjustment. Applying meta-analysis estimates, irrespective of CAC, aspirin use was estimated to result in net harm in individuals at low (<5%) and intermediate (5%-20%) 10-year ASCVD risk and net benefit in those at high (≥20%) ASCVD risk. Among individuals at lower bleeding risk, a CAC score of at least 100 identified individuals who would experience net benefit, but only in those at borderline or higher (≥5%) 10-year ASCVD risk. In individuals at higher bleeding risk, there would be net harm from aspirin irrespective of CAC and ASCVD risk. Higher CAC is associated with both ASCVD and bleeding events, with a stronger association with ASCVD. A high CAC score identifies individuals estimated to derive net benefit from primary prevention aspirin therapy from those who would not, but only in the setting of lower bleeding risk and estimated ASCVD risk that is not low.

<h3>Objective</h3> The risk of cardiovascular disease (CVD), including myocardial infarction (MI) and stroke, is increased in SLE patients and is underestimated by current prediction algorithms designed for the general population...

Atherosclerotic cardiovascular disease (ASCVD) risk calculators estimate the 10-year incident risk of myocardial infarction (MI), coronary artery disease (CAD) death, or stroke; however, they lack comprehensiveness and accuracy. Carotid intima-media thickness (CIMT) is a surrogate marker that may improve risk estimation acumen. The objective of this study was to derive ASCVD risk scores from historical data and determine whether these risk scores are associated with the history of subclinical CAD and CIMT. This retrospective cross-sectional study used an existing dataset of individuals with prediabetes. Subclinical CAD history was defined as the history of CAD, coronary plaque, or coronary revascularization without a history of MI. The online ASCVD Risk Estimator Plus calculator was used to derive individual risk scores. Chi-square or Fisher's exact tests for categorical variables and ANOVA for continuous variables detected differences among ASCVD risk categories. Linear regression of CIMT measurements on ASCVD risk scores ascertained ASCVD risk scores' utility in predicting CIMT measurements. The sample included 86 participants, 28% with a history of CAD, 60% male, and 95% White. No differences in risk scores existed between participants with or without CAD. Individuals with higher ASCVD risk scores were older (p ≤ .001) and had higher systolic blood pressure (p ≤ .001), CIMT arterial age (p = .003), mean IMT common (p ≤ .001), mean IMT maximum (p ≤ .001), and plaque burden (p = .02) measurements. ASCVD risk scores were significantly associated and moderately correlated with CIMT measurements. ASCVD risk scores were not associated with CAD history but were associated with CIMT measurements. While risk calculators provide a starting point for ASCVD risk estimation, physical tools like CIMT can diagnose ASCVD, categorize plaque quality, and track intervention efficacy. CIMT may be used for more direct ASCVD risk estimation. Risk scores are easily imputed from existing records but are only intended for incident risk, and their accuracy relies on the variables' availability and validity and the boundaries of the calculators.

Purpose: To examine the association between diabetic retinopathy (DR) and the atherosclerotic cardiovascular disease (ASCVD) risk score using the "ASCVD Risk Estimator Plus" tool in patients with type 2 diabetes mellitus (DM) and to assess risk factors potentially associated with DR. Methods: Participants in the study included 181 patients with type 2 DM who underwent a thorough ophthalmic examination, including a best-corrected visual acuity (BCVA) measurement, a dilated fundoscopy, fundus photography, an optical coherence tomography (OCT), and an OCT-angiography (OCT-A). DR was graded as no apparent retinopathy (NDR), mild non-proliferative (NPDR), moderate NPDR, severe NPDR, or proliferative DR (PDR). In addition, a detailed medical history of patients was recorded, while the "ASCVD Risk Estimator Plus" tool by the American College of Cardiology was used to calculate the ASCVD risk. Results: The ASCVD score, derived by the "ASCVD Risk Estimator Plus", was not found to be significantly correlated with DR (p = 0.191). Multivariable logistic regression analysis showed that factors associated with DR independently included DM duration (multivariable OR = 3.16, 95% CI: 1.55-6.44, p = 0.002), HbA1c levels (multivariable OR = 2.94, 95% CI: 1.37-6.32, p = 0.006), and the presence of neuropathy (multivariable OR = 3.59, 95% CI: 1.43-9.05, p = 0.007). In the multivariable multinomial logistic regression analysis, NPDR development was associated with duration of DM (multivariable RR = 3.31, 95% CI: 1.57-6.97, p = 0.002), HbA1c levels (multivariable RR = 2.24, 95% CI: 1.00-5.02, p = 0.050), and neuropathy (multivariable RR: 3.94, 95% CI: 1.54-10.11, p = 0.004), while PDR development was only associated with HbA1c levels (multivariable RR = 6.88, 95% CI: 2.19-21.63, p = 0.001). Conclusions: The ASCVD score, as it was calculated using the "ASCVD Risk Estimator Plus" tool, was not found to be significantly associated with DR. Factors significantly associated with DR were DM duration, HbA1c levels, and the presence of neuropathy.

Background: A potential adverse relationship between the consumption of low-calorie sweeteners and cardiovascular disease (CVD) risk has been proposed. High levels of circulating erythritol, a sugar alcohol (polyol) used as one of the non-nutritive sweeteners, have been recently linked to increased risks of major adverse cardiovascular events. However, associations of temporal changes in plasma erythritol and other polyols with cardiometabolic risk remain unclear. Hypothesis: We tested whether changes in plasma levels of non-nutritive sweetener erythritol and other polyols in response to weight-loss dietary interventions were associated with improved atherosclerotic cardiovascular disease (ASCVD) risk estimates and atherogenic lipoproteins among adults with overweight and obesity. Methods: This study included 804 adults (mean BMI: 32.7 [SD 3.9] kg/m 2 ) without diabetes or unstable CVD at baseline who participated in a 2-year intervention of weight-loss diets, the POUNDS Lost trial. Metabolomic profiling was performed to measure plasma erythritol and its precursor erythronate, other sugar alcohols, and low-calorie sweeteners at baseline and 6 months after randomization. The primary outcome was the change in 10-year ASCVD risk scores calculated by the validated pooled cohort equations. Two-year changes in lipid profiles and cholesterol [Chol] in lipoprotein subfractions defined by the presence or absence of apolipoprotein CIII (apoCIII) were analyzed as secondary outcomes. Results: The mean estimated value of the 10-year ASCVD risk was 4.0% at baseline; 16% of the participants were at intermediate or high ASCVD risk (score ≥7.5%). Higher levels of erythritol (per 1 SD increment: β 1.1% [SE 0.2%], p &lt;.0001) and erythronate (β 1.3% [0.2%], p &lt;.0001), as well as other sugar alcohols, such as mannitol-sorbitol, myoinositol, arabitol-xylitol ( p &lt;.0001 for all), and low-calorie sweetener saccharin ( p = 0.02), but not acesulfame ( p =0.8), were related to a higher ASCVD risk at baseline after adjusting for BMI. There was large variability in the changes in metabolite levels across participants; greater decreases in erythritol in response to the interventions were significantly related to greater reductions in ASCVD risk estimates at 6 months (per 1 SD reduction: β -0.2% [SE 0.1%]; p =0.023) and at 2 years (β -0.3% [0.1%]; p = 0.015) after adjusting for covariates, including BMI, the initial metabolite levels, and baseline ASCVD risk. The 6-month decrease in erythritol was associated with long-term (2-year) improvements in atherogenic lipids, including Chol in VLDL+LDL with apoCIII ( p &lt;0.05). Conclusions: Higher plasma levels of erythritol and other sugar alcohols were associated with greater 10-year ASCVD risk scores among adults with overweight and obesity. Weight-loss diet-induced decreases in erythritol levels were related to improved ASCVD risk and atherogenic lipid profiles.

Background: Patients with early-stage breast cancer are more likely to die from cardiovascular disease (CVD) than breast cancer. Aromatase inhibitors (AI) are used as adjuvant therapy in postmenopausal women with hormone receptor-positive breast cancer to improve survival rates, however, AI use has numerous adverse effects including increasing the risk of CVD due to negative effects on blood pressure and cholesterol levels. The American College of Cardiology/American Heart Association 2019 guidelines recommend that all patients at intermediate or high risk for CVD based on 10-year atherosclerotic cardiovascular disease (ASCVD) risk score be on a statin. We aimed to evaluate CVD risk and statin use among racially/ethnically diverse women with breast cancer on adjuvant AI therapy. Methods: We evaluated postmenopausal women with stage I-III breast cancer treated with AIs between 2007 and 2018 at Columbia University Irving Medical Center in New York, NY. Ten-year ASCVD risk score was calculated at breast cancer diagnosis from age (20-79 years), gender (female only), race (white/black/other), serum total cholesterol (130-320 mg/dL) and HDL cholesterol (20-100 mg/dL), systolic blood pressure (90-200 mm Hg), hypertension treatment (yes/no), diabetes (yes/no), and smoking status (current/former/never). Individuals were categorized based upon their 10-year ASCVD risk as low (&amp;lt;5%), borderline (5-7.5%), intermediate (7.5-20%), or high risk (&amp;gt;20%). We used descriptive statistics and multivariable logistic regression to determine predictors of statin use among patients with intermediate or high risk ASCVD risk scores. Results: Of 363 evaluable patients, median age at diagnosis was 64 years (range, 50-80) and 35.8% were non-Hispanic white, 32.5% Hispanic, 23.4% non-Hispanic black, and 8.3% other races. Overall, the proportion of women with low risk ASCVD risk was 25.6%, borderline risk was 8.0%, intermediate risk was 37.7%, and high risk was 28.7%. Mean 10-year ASCVD risk scores were 13.7% for black women, 11.5% Hispanics, and 11.0% for white women and other races (p=0.082). The percentage of patients on statins was 50% in the intermediate risk category and 77% in the high risk category. Among those with intermediate or high ASCVD risk scores (N=240), statin use was associated with higher ASCVD risk, higher total cholesterol and systolic blood pressure, and a diagnosis of hypercholesterolemia. Conclusions: Among women with early-stage breast cancer starting adjuvant AI therapy, there is a high prevalence with intermediate and high ASCVD risk. Given the effects of AI therapy on CVD risk factors, these patients should be screened for ASCVD risk and started on statin therapy when indicated. Citation Format: Monica F Chen, Morgan Manger, Katherine D Crew. Cardiovascular disease risk and statin use among women with breast cancer treated with adjuvant aromatase inhibitor therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-10-07.

Introduction: Despite recognized sex-difference in cardio-oncology, women are understudied due to lack of large and diverse data. The study examined atherosclerotic cardiovascular disease (ASCVD) risk in women veterans with breast, colorectal, lung, and thyroid cancer using Veterans Affairs (VA) national Electronic Health Records (EHR) data. Hypothesis: Elevated ASCVD risk in women with breast, colorectal, lung and thyroid cancer after cancer diagnosis due to accumulated cardiotoxicity induced from cancer therapy. Methods: We retrospectively followed 78,556 women veterans aged 30-79 from 2007 to 2017. We used AHA/ACC ASCVD risk score and VA women CVD risk score to measure ASCVD risk over the study period. Both scores included age, systolic blood pressure (treated/untreated), total cholesterol and HDL-C, smoking status, diabetes, and major depression. The study selected the top four most common cancers among women veterans. Discontinuity regression models were used to estimate trajectories of ASCVD risk at both pre and post cancer periods. Results: Both pre- and post-cancer ASCVD risk in women with breast, colorectal, and lung cancer was significantly elevated compared to the no cancer group, while women with thyroid cancer had lower ASCVD risk during the pre-cancer diagnosis. All women veterans with cancer except colorectal cancer showed premature aging in ASCVD risk after cancer diagnosis (Figure 1). Conclusions: Women cancer survivors are at increased risk of ASCVD not only post-cancer, but also long before their cancer diagnosis. ASCVD risk monitoring and management in women may serve as shared risk reduction and cancer prevention along with heightened cancer screening.

Background: Social determinants of health (SDoH) are linked with cardiovascular health, yet timely community-based atherosclerotic cardiovascular disease (ASCVD) risk assessment is often limited. We examine the associations between SDoH and ASCVD risk among older adults in Baltimore. Methods: In this cross-sectional study in 4 Black churches in Baltimore; we assessed the cardiovascular health of older adults ages 40-79 years. We estimated ASCVD risk using the 2013 ACC/AHA pooled cohort equation (PCE) and dichotomized risk as high (PCE ≥7.5%) versus low (PCE &lt;7.5%). An aggregate SDoH score was quantified as a cumulative number of adverse SDoH on a 7-item domain (primary care provider, health insurance, income, housing, support network, education, and employment) identified from the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) tool; and participants were divided into groups with no adverse and at least one adverse SDoH. Logistic regression models were fitted to examine the association between SDoH factors and ASCVD risk adjusting for sex and age. Results: Among 119 older Black adults, (mean age 59 ± 17 years, 79% female), mean systolic and diastolic BP were 130 ± 18.3 and 79 ± 10 mmHg, respectively. Overall, the mean ASCVD risk score was 13.08 (SD 10.2) with 69% having at least one adverse SDoH. From the adjusted model, compared with an income of &gt; $20,000, ASCVD risk was 3.28 greater (95% CI, 1.15 – 9.30) among those with low income ( &lt; $20,000). Compared with the employed, ASCVD risk was 6.63 higher (95% CI, 2.61-16.67) among those who are unemployed. Having at least one adverse SDoH was associated higher risk for ASCVD 7.25 (95% CI:1.53-12.71) compared with those without no adverse SDoH (Table ). Conclusion: We found a strong association between lower income, unemployment, and having at least one adverse SDoH with increased ASCVD risk. Our findings suggest a need for targeted socio-economic policies to address these SDoH, particularly among older Black individuals, rather than individual-level strategies alone.

BackgroundReports on the association between cardiovascular disease (CVD) risk and bone mineral density (BMD) remain inconsistent and hence more population-based studies on this subject are needed.AimsThis cross-sectional study aimed to evaluate the association between bone mineral density (BMD) at the lumbar spine (L1-L4) and femoral neck (right and left) with 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores in Saudi postmenopausal women.MethodsA cohort of 1,450 postmenopausal women with risk factors for bone loss were analyzed using the data from the Chair for Biomarkers of Chronic Diseases (CBCD) Osteoporosis database. BMD at the lumbar spine and femoral neck was assessed using dual-energy X-ray absorptiometry (DXA). Anthropometric and biochemical parameters, including fasting glucose and lipid profiles, were measured. ASCVD risk scores were calculated using the ASCVD Risk Estimator Plus tool. BMD tertiles were analyzed for their association with ASCVD risk.ResultsWomen with osteoporosis had significantly lower BMI, waist and hip circumferences, and metabolic dysfunction markers compared to those with normal BMD. Significant negative correlations were observed between ASCVD risk scores and BMD at femoral neck sites in women with osteopenia and osteoporosis. Multivariate logistic regression indicated that women in the lowest BMD tertiles had significantly higher odds of intermediate to high ASCVD risk scores, with adjusted odds ratios of 1.90 for the lumbar spine, 2.19 for the right femoral neck, and 2.04 for the left femoral neck.ConclusionsThe study identified significant associations between lower BMD at the lumbar spine and femoral neck sites and elevated 10-year ASCVD risk scores in postmenopausal women, particularly among those with osteopenia and osteoporosis. These findings demonstrate the importance of assessing cardiovascular risk in women with low BMD to enable early prevention and management strategies.

Background: The obesity epidemic is a significant health concern, affecting nearly a third of all United States citizens according to the 2013-2014 National Health and Nutrition Examination Survey. Obesity contributes to multiple metabolic and cardiovascular risk factors including diabetes mellitus, hypertension, and dyslipidemia. The atherosclerotic cardiovascular disease (ASCVD) risk calculator is a frequently used tool that aggregates various risk factors to assist physicians in detecting patients that may benefit from statin therapy and risk factor modification. However, this calculator does not directly factor in obesity, which has been found to be associated with multiple cardiovascular comorbidities. Our goal was to assess the correlation between body mass index (BMI) and ASCVD risk scores in order to identify potential targets for intervention to further decrease ASCVD risk. Methods: We obtained data from the medical record data warehouse of a primary care outpatient clinic predominantly run by internal medicine residents within a large safety-net hospital from January to December 2015. Patients with a diagnosis of dyslipidemia or hyperlipidemia were identified and electronic medical records were reviewed. ASCVD risk scores were calculated using the American College of Cardiology ASCVD risk estimator. Linear and logistical regression analyses were performed using SPSS software to assess the correlation between BMI and ASCVD risk. Results: The patient population was predominantly African American (92%, 1771 of 1919). Obesity (BMI ≥30) was present in 63% (1207 of 1919) of patients. ASCVD scores could be calculated for 914 patients and 90% (823 of 914) of these patients had ASCVD risk scores ≥7.5. However, only 84% (691 of 823) of these patients with elevated ASCVD scores were on a statin. Analyses did not reveal a correlation between BMI and ASCVD risk. However, elevated BMI (&gt;25) conferred an increased odds ratio (O.R.) of having elevated ASCVD risk (&gt;22.5% O.R. 1.58; p value 0.02) in comparison to normal or underweight BMI. Conclusion: Obesity rates appear to be higher in our patient population in comparison to national estimates but our mathematical model cannot be used to explain any correlation between BMI and ASCVD risk scores. Obesity did not confer an increased ASCVD risk in comparison to being overweight (BMI 25-29.9). However, both overweight and obese patients had a higher likelihood of having a significantly elevated ASCVD risk score. Future aims include initiating a targeted educational intervention for residents in the continuity clinic to ultimately demonstrate that resident driven intervention is an effective way to address obesity and modify ASCVD risk.

Hispanic/Latino ethnic background and genetic ancestry in relation to atherosclerotic cardiovascular disease risk estimation: Findings from the Multi-Ethnic Study of Atherosclerosis (MESA)

Objective: The purpose of this study was to investigate the association between the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score and the severity of nonalcoholic fatty liver disease (NAFLD), as determined by Fibroscan.Methodology: Patients with NAFLD who had Fibroscan to measure liver stiffness and steatosis presenting at the cardiology department of Liaquat National Hospital in Karachi, Pakistan were included in this cross-sectional investigation. Lipid profiles, waist circumference, liver enzyme levels, and 10-year ASCVD risk scores were among the demographic, clinical, and biochemical data gathered.Results: Of the 217 patients in the study, 62.2% had steatosis, and 99.1% were obese, indicating significant prevalence of liver disease and metabolic disorders. Most were older than 45 (75.1%) and female (62.2%). Low risk for ASCVD was 42.9%, moderate risk was 30.4%, intermediate risk was 11.5%, and high risk was 15.2%. Significant risk variables for ASCVD included advanced liver fibrosis (p&lt;0.05), higher blood cholesterol (p&lt;0.01), older age (p&lt;0.01), and the LDL to HDL ratio (p&lt;0.01). Males dominated higher ASCVD risk categories (p&lt;0.001), and the high-risk group had the highest prevalence of dyslipidemia, especially with metabolic syndrome (p&lt;0.001). There was a significant correlation between ASCVD risk and NAFLD severity as determined by fibroscopy (p=0.035).Conclusion: In conclusion, the study demonstrates a strong association between advanced NAFLD and increased ASCVD risk. Key risk factors, including age, serum cholesterol, LDL to HDL ratio, and liver fibrosis severity, were significantly linked to higher ASCVD risk (p&lt;0.05). Males and individuals with dyslipidemia, particularly those with metabolic syndrome, were more likely to be at higher risk.Keywords: Atherosclerosis, Cardiovascular Risk, Liver Fibrosis, Metabolic Syndrome, Nonalcoholic Fatty Liver Disease (NAFLD).

Erectile dysfunction (ED) is considered the tip of the iceberg for cardiovascular disease (CVD). However, there is still conflicting evidence regarding their relationship. Recently, a validated tool for the Atherosclerotic Cardiovascular Disease (ASCVD) risk score has provided a key opportunity to delve deeper into the relationship between ED and CVD. Therefore, we intended to assess the relationship between ED and 10-year ASCVD risk score. Complete data of 1207 participants from the 2001-2004 National Health and Nutrition Examination Survey (NHANES) were used in the study. Various weighted logistic and linear regression models were employed to investigate the effect of the presence of ED on the higher 10-Year ASCVD risk score or high risk of 10-Year ASCVD. Conversely, logistic regression models were repeated to explore the effect of continuous or categorical ASCVD risk score on the prevalence of ED. Sensitivity analyses were also conducted, focusing on severe ED with a more stringent definition. Additionally, we supplemented our study with subgroup analyses, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) analysis to enhance the robustness of our results. Participants with ED had higher ASCVD risk scores and a higher risk of ASCVD, which corresponded to a greater prevalence of ED or severe ED. When considering the presence of ED as the exposure, our results indicated that the presence of ED increased the ASCVD risk score (Model 3: β [95%CI]: 2.09 [1.12, 3.06]) in Model 3, as well as the high risk of ASCVD (OR [95%CI]: 2.27 [1.13, 4.59]). Conversely, a continuous increase in the ASCVD risk score was also associated with an increased prevalence of ED (OR [95%CI]: 1.04 [1.02,1.06]). Additionally, those in the borderline ASCVD risk group (OR [95% CI]: 2.95 [1.60, 5.44]), intermediate ASCVD risk group (OR [95% CI]: 4.53 [2.35, 8.73]), and high ASCVD risk group (OR [95% CI]: 7.62 [3.19, 18.19]) exhibited progressively increasing ED risk when compared to the low-risk group. Furthermore, the RCS analysis demonstrated a linear relationship between ED prevalence and the continuous ASCVD risk score, with the latter showing high efficacy in predicting ED (AUC [95%CI]: 0.794 [0.768, 0.821]). The presence of ED may precede the onset of ASCVD by some years. Consequently, timely and dynamic evaluation of the cardiovascular status provides an earlier opportunity to identify and implement effective prevention strategies to promote cardiovascular health for ED patients.

Our study examined whether osteocalcin contributed to identifying carotid intima-media thickness (C-IMT) over the atherosclerotic cardiovascular disease (ASCVD) risk score. We recruited 618 middle-aged and elderly men from communities in Shanghai. Serum osteocalcin levels were determined using an electrochemiluminescence immunoassay. C-IMT was measured by ultrasonography. The study included 245 men with low ASCVD risk and 373 men with moderate-to-high ASCVD risk. Serum osteocalcin levels were lower in the moderate-to-high risk vs. low risk men (p=0.042). Multivariate stepwise regression analysis showed that body mass index (BMI) and glycated hemoglobin were predictors for reduced osteocalcin levels (both p<0.001). Among all subjects, the proportion with an elevated C-IMT was higher in the low-osteocalcin group than in the high-osteocalcin group (p=0.042), and the significance of this result was greater when considering only subjects with a moderate-to-high ASCVD risk (p=0.011). The recognition rate of elevated C-IMT was superior with both low osteocalcin and moderate-to-high ASCVD risk vs. either parameter alone (p<0.001 and p=0.015, respectively). Osteocalcin was independently and inversely associated with elevated C-IMT after adjusting for the 10-year ASCVD risk score (p=0.004). The negative relationship remained statistically significant in subjects with a moderate-to-high ASCVD risk in particular (standardized β=-0.104, p=0.044). In middle-aged and elderly men, serum osteocalcin levels strengthen identifying subclinical atherosclerosis over ASCVD risk score, especially among subjects with a moderate-to-high ASCVD risk.

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.