Long-term changes in serum cholesterol level does not influence the progression of coronary calcification

Background A number of reports controversially describe the influence of cholesterol level and lipid-lowering treatment (LLT) on the progression of coronary calcium (CC). We tested the hypothesis that long-term changes in serum cholesterol (CL) would affect the progression of CC. Methods The study population comprised 510 patients with stable angina pectoris, mean age of 63±9years. At baseline 372 patients received statin and/or fibrate (LLT group) while 138 patients did not (No-LLT at baseline group). Spiral CT every 24months was used to track the progression of CC over a median 5.6year follow-up. Results CL decreased during follow-up in both groups, but more pronouncedly in patients with LLT. The changes in total calcium score (TCS) were similar in both groups (p=0.3). Changes in CL during follow-up were not associated with CC: TCS increased by 501±63 from baseline in the 1st (upper) quartile, and by 350±44, 403±41 and 480±56 in the 2nd, 3rd, and 4th quartiles of CL longitudinal changes (p=0.2), respectively. Baseline TCS and its changes were not correlated with baseline CL and its changes. New calcified lesions were diagnosed in 132 (28.2%) out of the 467 patients available for this analysis, without significant difference between groups (p=0.4). Multivariate analysis demonstrated that only baseline TCS (p<0.001), body mass index (p=0.007) and age (p=0.006) were independent predictors for the TCS changes. Conclusions Longitudinal CL changes do not seem to have a measurable effect on the rate of progression of CC.