Association between cumulative exposure to different lipid parameters and risk of newly developed carotid plaque

Background and purpose Both the magnitude and cumulative exposure of atherogenic lipoproteins have an impact on the atherosclerosis risk, and the exploration focus has shifted from one single lipoprotein assessment to the cumulative exposure of lipoproteins. We aim to investigate the relationship between cumulative exposure to different lipid parameters and the risk of newly developed carotid plaque in this study. Methods In the Asymptomatic Polyvascular Abnormalities Community study, 2947 participants were included with follow-up every 2 years from 2006 to 2012. Lipid parameters including total cholesterol (TC), triglycerides (TGs), low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol (HDLC) and non-HDLC were measured. Cumulative exposure was calculated by adding the weighted sum of the difference between the measured value and the cut-off value of each parameter. Newly developed carotid plaques were identified by carotid ultrasound performed at the third and fourth follow-ups. Results In the univariate analysis, non-HDLC burden had the highest ORs among the five lipid parameters for newly developed carotid plaque in each quartile, as 1.0 (reference), 1.35 (1.09-1.67), 1.68 (1.36-2.08) and 2.74 (2.22-3.38) from the lowest to the highest quartile. In the multivariate analysis and sensitivity analysis, we obtained similar results. Conclusions TC burden, TG burden, LDLC burden and non-HDLC burden are all independent risk factors for newly developed carotid plaque, especially for the vulnerable plaques. Among lipid parameters, non-HDLC burden is an optimal predictor. Moreover, the predictive value remained significant for participants under the age of 65 years old or free of hypertension, diabetes mellitus and hyperlipidaemia.

Automated summary

This study found that non-HDLC burden had the highest ORs for newly developed carotid plaque. TC burden, TG burden, LDLC burden, and non-HDLC burden are all independent risk factors, especially for vulnerable plaques. Among lipid parameters, non-HDLC burden is an optimal predictor.