Key result
High LDL-C linked to ~138% greater risk of carotid plaque instability.
Why the study?
Although reducing LDL-C lowers ischemic stroke risk, residual cardiovascular risk persists, prompting evaluation of the impact of dyslipidemia on carotid plaque instability across age and sex.
Does a dyslipidemic profile increase the risk of carotid plaque instability in patients undergoing endarterectomy, and is this modified by age and sex?
Observational (n=354)
No
Does a dyslipidemic profile increase the risk of carotid plaque instability in patients undergoing endarterectomy, and is this modified by age and sex?
High LDL-C combined with elevated remnant cholesterol or triglycerides significantly increases the risk of carotid plaque instability, particularly in women and patients under 70 years of age.
Answers are grounded in this paper and cite their sources.
May warrant remnant cholesterol assessment in carotid stenosis; leaves open whether lowering it reduces instability.
BACKGROUND: Dyslipidemia plays a critical role in carotid plaque instability and related cerebrovascular events. Reduction of low-density lipoprotein cholesterol (LDL-C) levels decreases ischemic stroke risk; however, a residual cardiovascular risk persists. Starting from this evidence, this study evaluated the impact of dyslipidemia on carotid plaque instability while also considering age and sex. METHODS: In this observational study, a total of 354 carotid plaques from symptomatic and asymptomatic patients undergoing endarterectomy were analyzed histologically. Dyslipidemic profiles, including high LDL-C, remnant cholesterol, triglycerides, and low high-density lipoprotein cholesterol, were assessed alongside other risk factors. Logistic regression identified independent predictors of unstable plaques, and subgroup analyses evaluated the influence of age (<70, ≥70 years) and sex. RESULTS: Unstable plaques were observed in 45.2% of cases. High LDL-C emerged as the strongest independent risk factor for plaque instability. The combination of high LDL-C with elevated remnant cholesterol or triglycerides significantly increased the risk of plaque destabilization. Age and sex influenced the risk associated with dyslipidemic profiles, with women who had elevated LDL-C combined with high-remnant cholesterol or triglycerides showing a substantially higher risk of carotid plaque instability compared with men. Furthermore, individuals <70 years of age exhibited a greater risk of plaque instability compared with older patients, highlighting the critical role of these nonmodifiable factors. CONCLUSIONS: The data reported here highlight the importance of a personalized medicine approach to lipid management, addressing not only LDL-C but also remnant cholesterol and triglycerides. Tailored interventions targeting specific dyslipidemic profiles could more effectively reduce the risk of carotid plaque rupture and cerebrovascular events, particularly in women and patients aged <70 years.
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Servadei et al. (2025) conducted an observational in Carotid plaque instability (n=354). High LDL-C (>100 mg/dL) vs. Low LDL-C (≤100 mg/dL) was evaluated on Unstable carotid plaque (OR 2.38, 95% CI 1.49-3.81, p=0.001). High LDL-C independently increased the risk of carotid plaque instability (OR 2.38), with the risk further amplified when combined with elevated remnant cholesterol or triglycerides.
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