Elevated LDL-C appears clinically meaningful even when coronary artery calcification (CAC) is absent. The European Heart Journal published findings from the Western Denmark Heart Registry including 23 777 symptomatic adults with CAC = 0 who underwent coronary computed tomography angiography (CCTA) between 2008 and 2021. The median age was 54 years, and 61% were women. The median follow-up was 7.1 years.

Non-calcified plaque was detected in 11% of participants. Per 1 mmol/L higher LDL-C, the aOR for non-calcified plaque was 1.21 (95% CI 1.16-1.27). Age-specific associations were strongest in those aged ≤45 years (aOR 1.39), followed by ages 46–60 years (aOR 1.22) and >60 years (aOR 1.11). During follow-up, 299 individuals experienced coronary heart disease (CHD). Per 1 mmol/L higher LDL-C, the aHR for CHD events was 1.28 (95% CI 1.13-1.46), also most pronounced at age ≤45 years.

These findings emphasize that LDL-C management remains important across ages, particularly in younger adults who may harbor early non-calcified atherosclerosis despite a CAC score of zero.