Cholesterol, Coronary Calcification, and Cardiovascular Prevention: Lessons We Can Learn From the Western Denmark Heart Registry
Bibliographic record
Abstract
n this issue of Circulation, Mortensen and colleagues 1 examine the relationship between low-density lipoprotein cholesterol (LDL-C) and the near-term risk of myocardial infarction or ischemic stroke in 23 132 consecutive subjects evaluated for nonemergency chest pain who were either coronary artery calcification (CAC) negative (CAC=0; n=12 430) or CAC positive (CAC>0; n=10 792).Not surprisingly, atherosclerotic cardiovascular disease events were substantially higher in the CAC>0 compared with the CAC=0 group (8.23 per 1000 patient-years [95% CI, 7.43-9.12]versus 3.45 per 1000 patient-years [95% CI, 2.99-3.98]).Also not surprisingly, the level of LDL-C was related to the risk of an atherosclerotic cardiovascular disease event in the total group (adjusted hazard ratio, 1.14 [95% CI, 1.04-1.24])and the CAC>0 group (adjusted hazard ratio, 1.18 [95% CI, 1.06-1.31]).Surprisingly, the level of LDL-C was not even close to predictive of the risk of an atherosclerotic cardiovascular disease event in the CAC=0 group (adjusted hazard ratio, 1.02 [95% CI, 0.87-1.18]).In addition, a very high LDL-C was associated with increased clinical risk compared with a low LDL-C, but only if CAC was >0.Moreover, similar results were obtained from an analysis of the MESA study (Multi-Ethnic Study of Atherosclerosis).Accordingly, there appeared to be consistent evidence of a clinically powerful interaction between LDL-C and CAC>0, which substantially increased atherosclerotic cardiovascular disease risk. 1 In contrast, LDL-C was not a statistically significant determinant of risk in those with CAC=0.Does this mean that LDL-C becomes a more malign actor after atherosclerotic dis-ease, as defined by CAC, is present than before, and that our diagnostic and treatment strategies should take this interaction into account?Does this mean that LDL-C, accepted by all as a causal factor for atherosclerosis, is not significantly related to cardiovascular risk in those with CAC=0?The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.051 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.019 | 0.017 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".