Key result
Borderline elevated baseline total cholesterol (≥5.18 mmol/L) with a moderate-stable trajectory was associated with carotid atherosclerosis progression (HR 1.416; 95% CI 1.285-1.559; p=0.000).
Why the study?
Early assessment of carotid atherosclerotic plaque characteristics is essential for ASCVD risk stratification, but the association of longitudinal lipid profile trajectories with carotid atherosclerosis progression required investigation.
Are borderline elevated baseline lipids with stable or elevated-increasing trajectories associated with carotid atherosclerosis progression?
Cohort (n=10,412)
No
Are borderline elevated baseline lipids with stable or elevated-increasing trajectories associated with carotid atherosclerosis progression?
Hazard Ratio: 1.416 (95% CI 1.285–1.559)
p-value: p=0.000
Borderline elevated baseline lipids with stable or increasing trajectories are associated with carotid atherosclerosis progression, supporting long-term strategies for maintaining low lipid levels.
Lipid trajectory associations with CAS progression are hypothesis-generating; prospective trials needed before any practice implications.
Background: Early assessment of carotid atherosclerotic plaque characteristics is essential for atherosclerotic cardiovascular disease (ASCVD) risk stratification and prediction. We aimed to identify different trajectories of lipid profiles and investigate the association of lipid trajectories with carotid atherosclerosis (CAS) progression in a large, longitudinal cohort of the Chinese population. Methods: 10,412 participants aged ≥18 years with ≥2 times general health checkups were included in this longitudinally prospective cohort study at Peking University Third Hospital. We used latent class trajectory models to identify trajectories of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) over follow-up time (757 days, IQR: 388–844 days). Results: Participants with carotid plaque were more likely to be older, male, have higher body mass index, have a higher prevalence of hypertension and diabetes, and have a higher level of blood pressure, TG, TC, and LDL-C, compared with carotid intima-media thickness (cIMT) and normal group. Subjects were trichotomized according to different trajectory patterns into stable, moderate-stable, and elevated-increasing classes. TC ≥ 5.18 mmol/L and moderate-stable class (hazard ratio (HR): 1.416, 95% confidence interval (CI): 1.285–1.559, p: 0.000), TG ≥ 1.70 mmol/L and moderate-stable class (HR: 1.492, 95% CI: 1.163–1.913, p: 0.002), TG ≥ 1.70 mmol/L and elevated-increasing class (HR: 1.218, 95% CI: 1.094–1.357, p: 0.000), LDL-C ≥ 3.36 mmol/L and stable class (HR: 1.500, 95% CI: 1.361–1.653, p: 0.000) were statistically significant associated with CAS progression compared with the reference group. Conclusions: Borderline elevated baseline lipid (TC, TG, and LDL-C) with stable and elevated-increasing trajectories were associated with CAS progression. Long-term strategies for low-level lipid are beneficial for ASCVD management.
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Yu et al. (2022) conducted a cohort in Carotid atherosclerosis progression (n=10,412). Lipid profile trajectories (TC, LDL-C, TG, HDL-C) vs. Reference group was evaluated on Carotid atherosclerosis (CAS) progression (HR 1.416, 95% CI 1.285-1.559, p=0.000). Borderline elevated baseline total cholesterol (≥5.18 mmol/L) with a moderate-stable trajectory was associated with carotid atherosclerosis progression (HR 1.416; 95% CI 1.285-1.559; p=0.000).
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