Elevated Castelli's risk index-II (CRI-II) independently predicted the presence of intraplaque neovascularization in patients with carotid stenosis, increasing the likelihood by 57% per one-unit increment (OR 1.57).
Cross-Sectional (n=321)
Yes
Does elevated Castelli's risk index II (LDL-C/HDL-C) predict intraplaque neovascularization in patients with carotid stenosis?
Castelli's risk index II (LDL-C/HDL-C) > 1.82 is an independent, readily accessible serological biomarker for identifying intraplaque neovascularization and vulnerable plaques in patients with carotid stenosis.
Effect estimate: OR 1.57 (95% CI 1.05-2.35)
p-value: p=0.028
Dyslipidemia is a well-established cause of atherosclerosis. Intraplaque neovascularization (IPN), a hallmark of vulnerable stroke-prone plaques, is a critical feature of dyslipidemia progression. However, the association between circulating lipid levels and IPN remains unclear. This study hypothesized that lipid ratios, particularly Castelli’s risk index-II (CRI-II; LDL-C/HDL-C), could function as biomarkers for IPN to help identify individuals at an elevated risk of ischemic stroke. A total of 321 patients with carotid stenosis underwent contrast-enhanced ultrasound (CEUS) to assess the presence of IPNs. Patients were categorized into IPN-positive (n = 265) and IPN-negative (n = 56) groups. Standard lipid parameters (total cholesterol TC, triglycerides TG, low-density lipoprotein cholesterol LDL-C, high-density lipoprotein cholesterol HDL-C, non-high-density lipoprotein cholesterol non-HDL-C) and derived ratios (non-HDL-C/HDL-C, CRI-I TC/HDL-C, CRI-II LDL-C/HDL-C) were compared between the two groups. Multivariate logistic regression analysis identified the independent predictors of IPN. Receiver operating characteristic (ROC) curve analysis was conducted to establish the optimal predictive thresholds for significant lipid ratios. Multivariable regression identified smoking (odds ratio OR 1.92, 95% confidence interval CI 1.06–3.46; P = 0.031) and elevated CRI-II (OR 1.57, 95% CI 1.05–2.35; P = 0.028) as independent predictors of IPN. ROC analysis identified a CRI-II threshold of > 1.82 as optimal for predicting IPN, achieving a sensitivity of 74.3% and specificity of 46.4%. CRI-II is a novel and readily calculated serological biomarker of IPN. A value exceeding 1.82 can be used to identify patients with carotid stenosis harboring high-risk vulnerable plaques. It provides a widely accessible and cost-effective strategy for refining stroke risk assessment and offers the potential to enhance preventive care strategies. ClinicalTrials.gov ID: NCT06315153.
Cui et al. (Sat,) conducted a cross-sectional in Carotid stenosis (n=321). Castelli's risk index II (CRI-II) was evaluated on Presence of intraplaque neovascularization (IPN) (OR 1.57, 95% CI 1.05-2.35, p=0.028). Elevated Castelli's risk index-II (CRI-II) independently predicted the presence of intraplaque neovascularization in patients with carotid stenosis, increasing the likelihood by 57% per one-unit increment (OR 1.57).