Association between non-high-density lipoprotein cholesterol levels and asymptomatic vulnerable carotid atherosclerotic plaques

The study on risk assessment of carotid plaques in the Northern Chinese population based on LASSO regression

Early identification and management of asymptomatic carotid plaques can reduce the risk of cardiovascular and cerebrovascular events. This study aimed to explore the factors that affect carotid plaques in the Northern Chinese population and construct a nomogram for risk assessment to identify high-risk populations for carotid artery plaques. A cross-sectional study on cardiovascular factors was conducted in Shijingshan District, Beijing, from January 2022 and August to September 2023, targeting individuals aged 18 years and above. Carotid plaques were assessed via carotid ultrasound. LASSO regression was used for feature selection, logistic regression was employed to analyze risk factors, and a risk assessment nomogram was also developed.. The performance was evaluated using the area under the receiver operating characteristic curve (AUC), and the calibration was assessed through the Hosmer‒Lemeshow goodness-of-fit test. The study included a total of 828 subjects, with 558 in the normal group and 270 in the carotid plaque group. Thirty-three risk factors were included in the LASSO regression analysis as independent variables for screening. The results of the adjusted multiple logistic regression analysis show that age (OR = 6.81, 95% CI:4.371-10.758), unmarried marital status (OR = 3.475, 95% CI: 1.927-6.554), current smoking (OR = 2.318, 95% CI: 1.519-3.553), hypertension history (OR = 1.794, 95% CI: 1.123-2.860), dyslipidemia history (OR = 1.920, 95% CI: 1.149-3.215), systolic blood pressure (SBP) (OR = 1.014, 95% CI: 1.004-1.024), GLU (OR = 1.135, 95% CI: 1.017-1.272), and malondialdehyde (MDA) (OR = 1.014, 95% CI: 1.003-1.025) were associated with an increased risk of carotid plaques.In contrast, higher education levels were associated with a lower risk of carotid plaques, with education level (3) (OR = 0.436, 95% CI: 0.208-0.917) and education level (4) (OR = 0.348, 95% CI: 0.170-0.718) indicating a protective association. The constructed nomogram Risk assessment had an AUC of 0.850 (95% CI: 0.823-0.877) and demonstrated good calibration (χ2 = 13.973, P = 0.08246). By integrating age, education level, marital status, current smoking, hypertension history, dyslipidemia history, SBP, GLU and MDA, we developed a high-performance nomogram for assessment., which may be helpful for the early detection and prevention of carotid plaques in the general population. Further studies may be useful to validate the applicability in different regions and populations.

Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hypertension in American adults: a NHANES cross-sectional study

Objectives

The relationship between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and hypertension remains uncertain, warranting further investigation. This study aims to elucidate the association between NHHR and hypertension.

Methods

A comprehensive cross-sectional stratified survey involving 30,602 participants aged 20 years and older was conducted using the National Health and Nutrition Examination Survey (NHANES) dataset from 2001 to 2018. NHHR was calculated as [total cholesterol (TC) - high-density lipoprotein cholesterol (HDL-C)]/HDL-C. The relationship between NHHR and hypertension was examined using weighted multiple linear regression, smooth curve fitting, hierarchical analysis, and interaction testing.

Results

The mean age of participants was 49.82 ± 17.64 years, with 15,266 women included. The average NHHR was 2.94 ± 0.56. A positive correlation between NHHR and hypertension was observed. Stratification of NHHR into quartiles, in the fully adjusted Model 3, revealed that individuals in the highest NHHR quartile had a 60% increased risk of hypertension for each unit increase in NHHR compared to those in the lowest quartile. Interaction tests indicated that the relationship between NHHR and hypertension remained consistent across subgroups, except for gender, age, education, and smoking status, which influenced this association.

Conclusion

Analysis of NHANES data from 2001 to 2018 demonstrated a consistent positive association between NHHR and hypertension. NHHR may provide potential assistance in hypertension prevention and diagnosis.

The Influence of Non-High-Density Lipoprotein Cholesterol on the Efficacy of Genotype-Guided Dual Antiplatelet Therapy in Preventing Stroke Recurrence

BACKGROUND AND PURPOSE

Non-high-density lipoprotein cholesterol (non-HDL-C), which represents the total cholesterol content of all pro-atherogenic lipoproteins, has recently been included as a new target for lipid-lowering therapy in high-risk atherosclerotic patients in multiple guidelines. Herein, we aimed to explore the relationship between non-HDL-C level and the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in preventing stroke recurrence.

METHODS

This study comprised a post hoc analysis of the CHANCE-2 (Ticagrelor or Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II) trial, from which 5,901 patients with complete data on non-HDL-C were included and categorized by median non-HDL-C levels, using a cutoff of 3.5 mmol/L. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days.

RESULTS

Ticagrelor-aspirin significantly reduced the risk of recurrent stroke in patients with low non-HDL-C (71 [4.8%] vs. 119 [7.7%]; adjusted hazard ratio [HR] 0.54; 95% confidence interval [CI], 0.40-0.74), but not in those with high non-HDL-C (107 [7.3%] vs. 108 [7.6%]; adjusted HR, 0.88; 95% CI, 0.67-1.16), compared with clopidogrel-aspirin (P for interaction=0.010). When analyzed as a continuous variable, the benefit of ticagrelor-aspirin for recurrent stroke decreased as non-HDL-C levels increased. No significant differences in the treatment assignments across the non-HDL-C groups were observed in terms of the rate of severe or moderate bleeding (5 [0.3%] vs. 8 [0.5%] in the low non-HDL-C group; 4 [0.3%] vs. 2 [0.1%] in the high non-HDL-C group; P for interaction=0.425).

CONCLUSION

CHANCE-2 participants with low non-HDL-C levels received more clinical benefit from ticagrelor-aspirin versus clopidogrel-aspirin compared to those with high non-HDL-C, following minor ischemic stroke or transient ischemic attack.

Role of neutrophil extracellular trap and immune infiltration in atherosclerotic plaque instability: Novel insight from bioinformatics analysis and machine learning

The instability of atherosclerotic plaques increases the risk of acute coronary syndrome. Neutrophil extracellular traps (NETs), mesh-like complexes consisting of extracellular DNA adorned with various protein substances, have been recently discovered to play an essential role in atherosclerotic plaque formation and development. This study aimed to investigate novel diagnostic biomarkers that can identify unstable plaques for early distinction and prevention of plaque erosion or disruption. Differential expression analysis was used to identify the differentially expressed NET-related genes, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed. We filtered the characteristic genes using machine learning and estimated diagnostic efficacy using receiver operating characteristic curves. Immune infiltration was detected using single-sample gene set enrichment analysis and the biological signaling pathways involved in characteristic genes utilizing gene set enrichment analysis were explored. Finally, miRNAs- and transcription factors-target genes networks were established. We identified 8 differentially expressed NET-related genes primarily involved in immune-related pathways. Four were identified as capable of distinguishing unstable plaques. More immune cells infiltrated unstable plaques than stable plaques, and these cells were predominantly positively related to characteristic genes. These 4 diagnostic genes are involved in immune responses and the modulation of smooth muscle contractility. Several miRNAs and transcription factors were predicted as upstream regulatory factors, providing further information on the identification and prevention of atherosclerotic plaques rupture. We identified several promising NET-related genes (AQP9, C5AR1, FPR3, and SIGLEC9) and immune cell subsets that may identify unstable atherosclerotic plaques at an early stage and prevent various complications of plaque disruption.

Separate and Joint Associations of Remnant Cholesterol Accumulation and Variability With Carotid Atherosclerosis: A Prospective Cohort Study

Background We aimed to examine separate and joint associations of remnant cholesterol (RC) accumulation and variability with the risk of carotid atherosclerosis (CAS) in the general population. Methods and Results A total of 6213 participants who underwent 3 sequential health examinations during 2010 to 2015 were enrolled and were followed up until December 31, 2021. Cumulative RC (cumRC) and RC variability among the 3 visits were the exposure of interest in our study. Adjusted Cox models were performed to calculate the hazard ratio (HR) and 95% CI. C-statistics, integrated discrimination improvement, and the net reclassification index were used to estimate the incremental predictive ability. During a median follow-up of 4.00 years, 2613 participants developed CAS. Higher cumRC (HR, 1.33 [95% CI, 1.17-1.52]) and greater RC variability (HR, 1.22 [95% CI, 1.08-1.39]) were significantly associated with elevated risk of CAS, independent of traditional cardiovascular risk factors and low-density lipoprotein cholesterol. Participants were divided into 4 groups according to the median of cumRC and RC variability to assess their joint associations. Compared with "low cumRC and low variability," "high cumRC and high variability" had the highest risk of CAS, followed by "high cumRC and low variability" and "low cumRC and high variability." Finally, joint assessment of RC accumulation and variability had the significantly highest incremental effect on the predictive value of CAS versus single-time-point measures of RC. Conclusions Excessive cumRC levels and greater RC variability were each independently associated with higher incidence of CAS, and their coexistence could further yield significantly higher risks.

Discordantly high Apo B with LDL-C or non-HDL-C in relation to presence and burden of cerebral atherosclerotic plaques

BACKGROUND

Data are limited on associations between apolipoprotein B (Apo B) and cerebral atherosclerosis.

OBJECTIVE

Our study aimed to estimate associations between discordant Apo B with low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (Non-HDL-C) and the odds of the presence and burden of intra-/extra-cranial atherosclerotic plaques.

METHODS

This cross-sectional study was based on the baseline survey from the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study, a population-based prospective cohort study. Participants with complete baseline data but without taking lipid-lowering medication were included in this analysis. Discordant Apo B with LDL-C or Non-HDL-C were defined by residuals and cut-off values (LDL-C: 3.4 mmol/L, Non-HDL-C: 4.1 mmol/L). We used binary and ordinal logistic regression models to explore associations between discordant Apo B with LDL-C or Non-HDL-C and the presence and burden of intra-/extra-cranial atherosclerotic plaques.

RESULTS

A total of 2,943 participants were enrolled in this study. Discordantly high Apo B with LDL-C was associated with an increased odds of the presence of intracranial atherosclerotic plaque [odds ratio (OR),1.28; 95%CI,1.01-1.61], intracranial atherosclerotic burden [common odds ratio (cOR), 1.31; 95%CI,1.04-1.64], the presence of extracranial atherosclerotic plaque (OR, 1.37; 95%CI,1.14-1.66), and extracranial atherosclerotic burden (cOR, 1.32; 95%CI,1.10-1.58) compared with the concordant group. Discordantly low Apo B with Non-HDL-C was associated with decreased odds of the presence and burden of intra-/extra-cranial atherosclerotic plaques.

CONCLUSION

Discordantly high Apo B with LDL-C or Non-HDL-C were associated with an increased odds of the presence and burden of intra-/extra-cranial atherosclerotic plaques. This demonstrated that discordantly high Apo B might be important for early assessment of risk of cerebral atherosclerotic plaques in addition to LDL-C and Non-HDL-C.

Development and validation of explainable machine-learning models for carotid atherosclerosis early screening

BACKGROUND

Carotid atherosclerosis (CAS), an important factor in the development of stroke, is a major public health concern. The aim of this study was to establish and validate machine learning (ML) models for early screening of CAS using routine health check-up indicators in northeast China.

METHODS

A total of 69,601 health check-up records from the health examination center of the First Hospital of China Medical University (Shenyang, China) were collected between 2018 and 2019. For the 2019 records, 80% were assigned to the training set and 20% to the testing set. The 2018 records were used as the external validation dataset. Ten ML algorithms, including decision tree (DT), K-nearest neighbors (KNN), logistic regression (LR), naive Bayes (NB), random forest (RF), multiplayer perceptron (MLP), extreme gradient boosting machine (XGB), gradient boosting decision tree (GBDT), linear support vector machine (SVM-linear), and non-linear support vector machine (SVM-nonlinear), were used to construct CAS screening models. The area under the receiver operating characteristic curve (auROC) and precision-recall curve (auPR) were used as measures of model performance. The SHapley Additive exPlanations (SHAP) method was used to demonstrate the interpretability of the optimal model.

RESULTS

A total of 6315 records of patients undergoing carotid ultrasonography were collected; of these, 1632, 407, and 1141 patients were diagnosed with CAS in the training, internal validation, and external validation datasets, respectively. The GBDT model achieved the highest performance metrics with auROC of 0.860 (95% CI 0.839-0.880) in the internal validation dataset and 0.851 (95% CI 0.837-0.863) in the external validation dataset. Individuals with diabetes or those over 65 years of age showed low negative predictive value. In the interpretability analysis, age was the most important factor influencing the performance of the GBDT model, followed by sex and non-high-density lipoprotein cholesterol.

CONCLUSIONS

The ML models developed could provide good performance for CAS identification using routine health check-up indicators and could hopefully be applied in scenarios without ethnic and geographic heterogeneity for CAS prevention.

Circulating MicroRNAs as Potential Biomarkers for Ischemic Stroke in Patients with Asymptomatic Intracranial Artery Stenosis

Circulating microRNAs have been shown to be biomarkers of various diseases. We aimed to investigate whether circulating microRNA can serve as a biomarker to predict ischemic stroke risk in asymptomatic intracranial artery stenosis. A total of 716 participants from the Asymptomatic Polyvascular Abnormalities Community study who had asymptomatic intracranial artery stenosis at baseline were enrolled (2010-11). Patients who suffered incident ischemic stroke were classified into the case group, and age- and sex-matched individuals without stroke were used as controls. MicroRNA microarrays were used to distinguish baseline circulating serum microRNA levels between the case and the control groups (GEO accession number GSE201860). The differentially expressed microRNAs were validated by real-time PCR. MicroRNA microarrays were performed in baseline serum samples from12 subjects who developed ischemic stroke and 12 age- and sex-matched subjects without stroke during the 2014-15 follow-up period. Twenty microRNAs were differentially expressed between the two groups (fold change > 1.3 and p < 0.05 for all). Hsa-miR-486-5p, hsa-miR-92a-3p, hsa-miR-6089 from them were selected and validated in the baseline serum samples of ten subjects with incident ischemic stroke and another ten age- and sex-matched subjects without stroke during the 2016-17 follow-up period. Hsa-miR-1225-5p, with a large fold change value and a reported relationship with cardiovascular or cerebrovascular diseases, was also validated. Ultimately, only hsa-miR-6089 was differentially downregulated among patients with intracranial artery stenosis who developed ischemic stroke (p < 0.05). In patients with asymptomatic intracranial artery stenosis, downregulated serum hsa-miR-6089 may be associated with the risk of ischemic stroke.

Non-HDL-C/HDL-C ratio is associated with carotid plaque stability in general population: A cross-sectional study

Background

Carotid atherosclerosis, especially the rupture of unstable plaques, plays an important role in the development of stroke. A novel lipid ratio, the non-high-density lipoprotein cholesterol (non-HDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio, contains both atherogenic and anti-atherogenic particle information, and has been shown to be associated with carotid atherosclerosis. However, there is no data on evaluating the association between non-HDL-C/HDL-C ratio and carotid plaque stability.

Methods

This study was carried out on 27,436 urban workers aged 20 years or older who participated in a comprehensive health screening between January 2016 and December 2017. Carotid plaque stability was assessed using ultrasonography. Multinomial logistic regression models were used to explore the relationship between the non-HDL-C/HDL-C ratio and carotid plaque stability by odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were performed to verify the robustness of the results.

Results

Carotid plaque was detected in 7,161 (26.1%) participants, with stable and unstable plaque accounting for 3,277 (11.9%) and 3,884 (14.2%), respectively. The prevalence of stable carotid plaque substantially increased with increasing non-HDL-C/HDL-C ratio quartile levels (p for trend < 0.001) and with a similar association for unstable carotid plaque (p for trend < 0.001). The mean non-HDL-C/HDL-C ratios (mean ± SD) of non-carotid plaque (2.9 ± 1.1), stable carotid plaque (3.2 ± 1.2), and unstable carotid plaque (3.4 ± 1.4) gradually increased (p < 0.001). In multinomial logistic regression, ORs (95% CIs) for the highest vs. lowest quartile of the non-HDL-C/HDL-C ratio were 1.70 (1.48-1.95) between stable carotid plaques and no carotid plaque, 2.34 (2.06-2.67) between unstable carotid plaques and no carotid plaque, and 1.38 (1.18-1.61) between unstable carotid plaques and stable carotid plaque, after adjusting for common cardiovascular risk factors. The results of subgroup analysis and sensitivity analysis were similar.

Conclusion

Our findings suggested that the non-HDL-C/HDL-C ratio was significantly associated with carotid plaque stability and might be a useful indicator for the early identification of high-risk carotid plaque.

Identification Markers of Carotid Vulnerable Plaques: An Update

Vulnerable plaques have been a hot topic in the field of stroke and carotid atherosclerosis. Currently, risk stratification and intervention of carotid plaques are guided by the degree of luminal stenosis. Recently, it has been recognized that the vulnerability of plaques may contribute to the risk of stroke. Some classical interventions, such as carotid endarterectomy, significantly reduce the risk of stroke in symptomatic patients with severe carotid stenosis, while for asymptomatic patients, clinically silent plaques with rupture tendency may expose them to the risk of cerebrovascular events. Early identification of vulnerable plaques contributes to lowering the risk of cerebrovascular events. Previously, the identification of vulnerable plaques was commonly based on imaging technologies at the macroscopic level. Recently, some microscopic molecules pertaining to vulnerable plaques have emerged, and could be potential biomarkers or therapeutic targets. This review aimed to update the previous summarization of vulnerable plaques and identify vulnerable plaques at the microscopic and macroscopic levels.

Predictive Value of Non-high-Density Lipoprotein Cholesterol and Neutrophil-Lymphocyte Ratio for Coronary Artery Vulnerable Plaques in Type 2 Diabetes Mellitus

Background

Patients with diabetes have an increased risk of developing vulnerable plaques (VPs), in which dyslipidemia and chronic inflammation play important roles. Non-high-density lipoprotein cholesterol (non-HDL-C) and neutrophil-lymphocyte ratio (NLR) have emerged as potential markers of both coronary artery VPs and cardiovascular prognosis. This study aimed to investigate the predictive value of non-HDL-C and NLR for coronary artery VPs in patients with type 2 diabetes mellitus (T2DM).

Methods

We retrospectively enrolled 204 patients with T2DM who underwent coronary computed tomography angiography between January 2018 and June 2020. Clinical data including age, sex, hypertension, smoking, total cholesterol, low-density lipoprotein cholesterol, HDL-C, triglyceride, non-HDL-C, glycated hemoglobin, neutrophil count, lymphocyte count, NLR, and platelet count were analyzed. Multivariate logistic regression was used to estimate the association between non-HDL-C, NLR, and coronary artery VPs. Receiver operating curve analysis was performed to evaluate the value of non-HDL-C, NLR, and their combination in predicting coronary artery VPs.

Results

In our study, 67 patients (32.84%) were diagnosed with VPs, 75 (36.77%) with non-VP, and 62 (30.39%) with no plaque. Non-HDL-C and NLR were independent risk factors for coronary artery VPs in patients with T2DM. The areas under the ROC curve of non-HDL-C, NLR, and their combination were 0.748 [95% confidence interval (CI): 0.676-0.818], 0.729 (95% CI: 0.650-0.800), and 0.825 (95% CI: 0.757-0.887), respectively.

Conclusion

Either non-HDL-C or NLR could be used as a predictor of coronary artery VPs in patients with T2DM, but the predictive efficiency and sensitivity of their combination would be better.

Carotid intima-media and epicardial adipose tissue thickness in adult patients with epilepsy taking anti-seizure medication and its long-term significance

OBJECTIVES

We investigated epicardial adipose tissue thickness (EATT), carotid intima-media thickness (CIMT), and lipid profile in adult patients with epilepsy (PWE) taking anti-seizure medication(s) (ASM) and compared with those of the healthy population. We also investigated whether duration of follow-up and number of ASM(s) (mono- vs. polytherapy) affect these risk factors.

METHODS

Twenty PWE older than 18 years of age were recruited at the outpatient epilepsy clinic and compared to twenty controls. Patients who were 18 years old and younger, those with cardiovascular risk factors, and patients with follow-up duration less than 2 years were excluded from the study.

RESULTS

Epicardial adipose tissue thickness and CIMT were thicker compared to controls. While patients' low-density lipoprotein (LDL) levels were higher than controls, and high-density lipoprotein (HDL) levels were lower, the levels were in normal ranges. Those patients with duration of follow-up more than five years had thicker EATT. The 5-year LDL was in normal ranges while HDL was abnormally low. Number of ASM(s) was not associated with increased risks of atherosclerosis. Increased CIMT in patients taking ASM(s) was independent of their lipid profile.

CONCLUSION

Anti-seizure medications contribute to accelerated atherosclerosis in people with epilepsy. Chronic use of ASMs may increase this chance. It is appropriate to use ASM(s) with lower chances of atherosclerosis in people with epilepsy and encourage them to change their lifestyle in order to modify cardiovascular risk factors. Meantime, it is reasonable to assess the risk of atherosclerosis periodically in these patients by noninvasive methods including lipid profile, CIMT, and EATT.

Non-stenotic Carotid Plaques in Embolic Stroke of Unknown Source

Embolic stroke of unknown source (ESUS) represents one in five ischemic strokes. Ipsilateral non-stenotic carotid plaques are identified in 40% of all ESUS. In this narrative review, we summarize the evidence supporting the potential causal relationship between ESUS and non-stenotic carotid plaques; discuss the remaining challenges in establishing the causal link between non-stenotic plaques and ESUS and describe biomarkers of potential interest for future research. In support of the causal relationship between ESUS and non-stenotic carotid plaques, studies have shown that plaques with high-risk features are five times more prevalent in the ipsilateral vs. the contralateral carotid and there is a lower incidence of atrial fibrillation during follow-up in patients with ipsilateral non-stenotic carotid plaques. However, non-stenotic carotid plaques with or without high-risk features often coexist with other potential etiologies of stroke, notably atrial fibrillation (8.5%), intracranial atherosclerosis (8.4%), patent foramen ovale (5-9%), and atrial cardiopathy (2.4%). Such puzzling clinical associations make it challenging to confirm the causal link between non-stenotic plaques and ESUS. There are several ongoing studies exploring whether select protein and RNA biomarkers of plaque progression or vulnerability could facilitate the reclassification of some ESUS as large vessel strokes or help to optimize secondary prevention strategies.

Non-traditional Lipid Parameters as Potential Predictors of Asymptomatic Intracranial Arterial Stenosis

Background: Intracranial arterial stenosis (ICAS) is a common cause of stroke. Identifying effective predictors of ICAS that could be easily obtained in clinical practice is important. The predictive values of serum individual lipid parameters have been well-established. In recent years, several non-traditional lipid parameters demonstrated greater predictive values for cardiovascular disease and ischemic stroke than traditional individual lipid parameters. However, their effects on asymptomatic ICAS (aICAS) are less clear. Therefore, we sought to observe the effects of non-traditional lipid parameters on aICAS. Methods: We enrolled 5,314 participants from the Asymptomatic Polyvascular Abnormalities in Community study. Asymptomatic ICAS was detected by transcranial Doppler ultrasonography (TCD). Non-traditional lipid parameters, including non-high-density lipoprotein cholesterol (non-HDL-C), the triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic coefficient (AC), atherogenic index of plasma, and Castelli's risk index (CRI) were measured. We used multivariable logistic analysis to assess the association of different lipid parameters with aICAS; a trend test and subgroup analyses were also performed. Results: In total, 695 of 5,314 participants had aICAS in this study. For the comparison of the highest to the lowest tertile, the multivariable-adjusted odds ratios (ORs) (95% CIs) were 1.78 (1.39-2.27) (p trend < 0.001) for non-HDL-C, 1.48 (1.18-1.85) (p trend = 0.004) for the AC, 1.48 (1.18-1.85) (p trend = 0.004) for CRI-I, and 1.34 (1.09-1.66) (p trend = 0.032) for CRI-II. Subgroup analyses showed significant interactions between the AC, CRI-I, and diabetes. Conclusions: This large community-based study showed that non-HDL-C, AC, CRI-I, and CRI-II were significantly associated with increased prevalence of aICAS.

Association Between Cumulative Exposure to Increased Low-Density Lipoprotein Cholesterol and the Prevalence of Asymptomatic Intracranial Atherosclerotic Stenosis

Background and Purpose: Intracranial atherosclerosis has gained increasing attention due to the high risk of recurrent clinical or subclinical ischemic events, while the relationship between low-density lipoprotein cholesterol (LDL-C) measured at a single time point and intracranial atherosclerotic stenosis (ICAS) is inconsistent. This study aims to assess the association between cumulative exposure to increased LDL-C and the prevalence of asymptomatic ICAS.

Methods: The Asymptomatic Polyvascular Abnormalities Community study was investigated on the epidemiology of asymptomatic polyvascular abnormalities in Chinese adults. In this study, we included 4,523 participants with LDL-C measured at 3 examinations in 2006, 2008, and 2010. Cumulative exposure to increased LDL-C was calculated as following: LDL-C burden_2006−2008 = [(LDL-C₂₀₀₆-1.8) + (LDL-C₂₀₀₈-1.8)]/2 ^* time_2006−2008; LDL-C burden = LDL-C burden_2006−2008 + LDL-C burden_2008−2010. Transcranial doppler ultrasonography was performed in 2010 to detecting the ICAS.

Results: Of the 4,347 patients, 13.3% (580/4,347) were diagnosed with ICAS. In univariate analysis, the association between LDL-C burden and ICAS prevalence was significant, the odds ratios (95% confidence interval) from the lowest to the highest quartile were 1 (reference), 1.30 (0.99–1.70), 1.32 (1.01–1.73), and 2.14 (1.66–2.75), respectively (P < 0.05). After adjustment for potential confounding factors, the same result was reached.

Conclusions: Cumulative exposure to increased LDL-C is concentration-dependently associated with increased prevalence of asymptomatic ICAS, especially in those under the age of 65 y or free of hypertension, diabetes mellitus, and hyperlipidemia.

Relationship between the non-HDLc-to-HDLc ratio and carotid plaques in a high stroke risk population: a cross-sectional study in China

BACKGROUND

Evidence on the association between the non-high-density lipoprotein cholesterol (non-HDLc)-to-high-density lipoprotein cholesterol (HDLc) ratio (non-HDLc/HDLc) and carotid plaques is still limited. This study aims to assess the relationship between the non-HDLc/HDLc and carotid plaques in a population with a high risk of stroke.

METHODS

A cross-sectional study based on the community was conducted in Yangzhou, China. Residents (no younger than 40 years old) underwent questionnaire interviews, physical examinations, and laboratory testing during 2013-2014. The subjects with a high risk of stroke were further selected (at least three of eight risk factors including hypertension, atrial fibrillation, type 2 diabetes mellitus, dyslipidaemia, smoking, lack of exercise, overweight, and family history of stroke) or a transient ischaemic attack (TIA) or stroke history. Carotid ultrasonography was then performed on the high stroke risk participants. Carotid plaque was defined as a focal carotid intima-media thickness (cIMT) ≥1.5 cm or a discrete structure protruding into the arterial lumen at least 50% of the surrounding cIMT. Logistic regression was employed to evaluate the relationship between the non-HDLc/HDLc and carotid plaques.

RESULTS

Overall, 839 subjects with a high risk of stroke were ultimately included in the analysis, and carotid plaques were identified in 341 (40.6%) of them. Participants in the highest non-HDLc/HDLc tertile group presented a higher proportion of carotid plaques than did those in the other two groups. After adjustment for other confounders, each unit increase in the non-HDLc/HDLc was significantly associated with carotid plaques (OR 1.55, 95%CI 1.28-1.88). In the subgroup analysis, the non-HDLc/HDLc was positively and significantly associated with the presence of carotid plaques in most subgroups. Additionally, the non-HDLc/HDLc interacted significantly with three stratification variables, including sex (OR 1.31 for males vs. OR 2.37 for females, P interaction = 0.016), exercise (OR 1.18 for subjects without lack of exercise vs. OR 1.99 for subjects with lack of exercise, P interaction = 0.004) and heart diseases (OR 1.40 for subjects without heart diseases vs. OR 3.12 for subjects with heart diseases, P interaction = 0.033).

CONCLUSION

The non-HDLc/HDLc was positively associated with the presence of carotid plaques in a Chinese high stroke risk population. A prospective study or randomized clinical trial of lipid-lowering therapy in the Chinese population is needed to evaluate their causal relationship.