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May 8, 2026European Stroke JournalOpen Access

Abstract Number: Esoc2026a1293 Lipid Biomarkers and Carotid Intraplaque Hemorrhage: Interim Analysis of the Prospective Multicenter Ageless Study

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Key result

Higher LDL-C is linked to ~45% greater risk of carotid intraplaque hemorrhage, unlike Lp(a) and ApoB.

  • aOR 1.45
  • 95% CI 1.11-1.88
  • n=355

Why the study?

Carotid intraplaque hemorrhage indicates plaque vulnerability, but whether lipid drivers of atherosclerosis like LDL-C, Lp(a), and ApoB are associated with it remains unclear.

Population

355 patients with asymptomatic or symptomatic carotid stenosis ≥30% (NASCET)

Comparison

Associations across lipid parameters (Lp(a), LDL-C, ApoB)

Design

Prospective, observational, multicenter study

Authors

TDTolga DittrichDVDimitrios VlachosMCMelissa Correia

Discussion

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Overview

Should not yet alter lipid targets in carotid disease; leaves open whether LDL-C lowering reduces IPH and subsequent stroke risk.

Key Points

  • To examine the connections between lipid biomarkers and carotid intraplaque hemorrhage in patients with carotid stenosis.
  • Prospective observational multicenter study with patients having carotid stenosis ≥30% (N=355)
  • Standardized carotid plaque MRI performed on participants
  • Logistic regression analyses adjusted for confounding factors including age and smoking.
  • 154 (43.4%) patients had carotid intraplaque hemorrhage (IPH)
  • LDL-C showed an independent association with IPH (per +1 mmol/L aOR 1.45, 95%CI 1.11–1.88)
  • Associations for symptomatic carotid stenosis were strong for LDL-C (per +1 mmol/L aOR 2.00, 95%CI 1.51–2.66) and ApoB (per +0.1 g/L aOR 1.13, 95%CI 1.02–1.26).

Study Design

Type

Observational (n=355)

Multicenter

Yes

Structured PICO

P
Population
355 patients with asymptomatic or symptomatic carotid stenosis ≥30% (NASCET) undergoing standardized carotid plaque MRI
O
Outcome
Carotid intraplaque hemorrhage (IPH) and symptomatic stenosissurrogate

Main Result

Effect estimate: aOR 1.45 (95% CI 1.11-1.88)

In patients with carotid stenosis, higher LDL-C is independently associated with carotid intraplaque hemorrhage and symptomatic disease, whereas Lp(a) is not.

Limitations

  • Smaller effects may have remained undetected due to sample size and IPH prevalence.
  • Smaller effects may have remained undetected due to sample size and IPH prevalence

Cite This Study

Dittrich et al. (2026) conducted an observational in Carotid stenosis (n=355). Lipid biomarkers (LDL-C, Lp(a), ApoB) was evaluated on Carotid intraplaque hemorrhage (IPH) (aOR 1.45, 95% CI 1.11-1.88). Higher LDL-C levels were independently associated with carotid intraplaque hemorrhage (aOR 1.45; 95% CI 1.11–1.88), whereas Lp(a) and ApoB showed no independent association.

synapsesocial.com/papers/69fd7e23bfa21ec5bbf065a1https://doi.org/10.1093/esj/aakag023.083
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The association of lipoprotein(a) and intraplaque neovascularization in patients with carotid stenosis: a retrospective study2021 · 16 citations
  2. 2Lipids and carotid plaque in the Northern Manhattan Study (NOMAS)2009 · 61 citations
  3. 3Lipoprotein(a) levels and atherosclerotic plaque characteristics in the carotid artery: The Plaque at RISK (PARISK) study2021 · 55 citations
  4. 4The Relationship between Intracarotid Plaque Neovascularization and Lp (a) and Lp-PLA2 in Elderly Patients with Carotid Plaque Stenosis2022 · 7 citations
  5. 5Incremental value of carotid intraplaque hemorrhage for discriminating prior coronary events2015 · 2 citations