Abstract
Background/Objectives: Given the conflicting results and limited published data on the correlation of vitamin A, E, and D, parathyroid hormone (PTH), and thyroid-stimulating hormone (TSH) levels, the triglyceride to high-density lipoprotein (TG/HDL) ratio, and glucose levels with the coronary artery calcium score (CAC score) in individuals at risk of coronary artery disease (CAD), this relationship requires extensive investigation. Therefore, our study aimed to investigate the correlations between the aforementioned metrics and the CAC score in individuals at risk of CAD in Saudi Arabia. Methods: This analytical cross-sectional study was conducted at the Department of Physiology, College of Medicine at King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia, between November 2024 and April 2025, targeting patients at risk of CAD. After recruiting patients from cardiology and primary care clinics, data regarding blood vitamin A, E, and D and PTH and TSH levels and CAC scores were collected from each patient's electronic medical records. A score of 10 points was used as a cutoff between low and high CAC scores. Results: Our sample size was 172 patients. The majority of the patients were male (62.2%), and 37.8% were female. The mean age of the sample was 59.98 ± 9.26 years, with an age range spanning 40 years. Serum vitamin A levels had a significant negative correlation with CAC scores, (odds ratio (OR) = 0.147, p-value = 0.002), whereas vitamin D and E, PTH, and TSH levels did not correlate with this score. The TG/HDL ratio was positively and significantly correlated with CAC scores (OR = 1.654, p-value = 0.030). The analysis model showed that a patient's mean serum glycated hemoglobin (HbA1c) level positively and significantly influenced their odds of having a high CAC score (OR = 1.364, p-value = 0.018). Patient ethnicity was not significantly associated with the CAC score (CAC ≥ 10 points) (p = 0.749). Similarly, BMI did not correlate with the CAC score (p = 0.722). However, male patients were 3.42 times more likely than females to have a high CAC score (CAC ≥ 10 points), a statistically significant difference (p = 0.005). No significant differences were observed between males and females in terms of their mean vitamin A (1.74 ± 0.58 vs. 1.80 ± 0.52, p = 0.633), vitamin E (41.41 ± 15.99 vs. 37.61 ± 11.78, p = 0.189), or vitamin D levels (80.35 ± 31.07 vs. 77.16 ± 26.15, p = 0.479). Additionally, the patient's age was significantly positively associated with the likelihood of having a high CAC score, with OR = 1.102 times (p < 0.001). Conclusions: The findings of our study indicate the strong impact of vitamin A, the TG/HDL ratio, and HbA1c on CAC scores, among other factors affecting CAC scores, and they need more concern and attention. Understanding the cellular mechanism of vitamin A correlation with calcification is of great clinical value. The TG/HDL ratio is emerging as a novel index for CVD when compared to other lipid profile parameters. Intensive large-scale studies are needed to explore the interpretations as well as cutoff values of this valuable index. Males are more prone to CVD due to their high correlation with CAC scores. Therefore, vitamin A administration and strict HbA1c and TG/HDL ratio monitoring could help as prophylactic measures to prevent cardiovascular disease in these patients. These findings could influence specific preventive measures or screening strategies for cardiovascular disease in high-risk populations. A lifestyle medicine approach that involves caregivers as well as patients should be implemented to minimize the incidence and complications of detrimental diseases.