Key result
Higher LDL-C and TG/HDL-C ratio linked to ~12% increased odds of carotid plaque.
Why the study?
While associations of LDL-C and the TG/HDL-C ratio with carotid atherosclerosis are known, their age-varying trajectories remain unclear.
Do LDL-C and TG/HDL-C ratio exhibit age-specific patterns in their association with carotid plaque in adults?
Cross-Sectional (n=21,227)
No
Do LDL-C and TG/HDL-C ratio exhibit age-specific patterns in their association with carotid plaque in adults?
Odds Ratio: 1.12 (95% CI 1.08–1.17)
p-value: p=<0.001
LDL-C is strongly associated with carotid plaque in younger adults but attenuates with age, whereas the TG/HDL-C ratio maintains a stable association across the lifespan, suggesting age-specific lipid assessment strategies may be needed.
Background While the associations of low-density lipoprotein cholesterol (LDL-C) and the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C) with carotid atherosclerosis are known, their age-varying trajectories remain unclear. This study aimed to characterize the age-specific heterogeneity in these associations using a large Chinese health check-up cohort. Methods We retrospectively enrolled 23,058 adults undergoing carotid ultrasonography. After exclusions, 21,227 participants were included. Multivariate logistic regression evaluated the independent associations of LDL-C and TG/HDL-C with carotid plaque. Age-stratified analyses (<40, 40–49, 50–59, 60–69, ≥70 years) and interaction tests were performed. Sensitivity analyses included substituting non-HDL-C for LDL-C and the triglyceride-glucose index (TyG index) for TG/HDL-C. Associations with hypoechoic plaques were also assessed. Results The carotid plaque detection rate was 31.4% (6,657/21,227). Both LDL-C (OR = 1.12, 95% CI: 1.08–1.17, P < 0.001) and TG/HDL-C (OR = 1.11, 95% CI: 1.07–1.15, P < 0.001) were independently associated with plaque. However, their age patterns diverged significantly. The association of LDL-C was strongest in participants aged <40 years (OR = 1.51, 95% CI: 1.30–1.76) but attenuated with age, becoming non-significant in those ≥60 years ( P for interaction <0.001). Conversely, the TG/HDL-C association remained stable across age groups, with the numerically highest ORs observed in the <40 and 50–59 age groups (OR = 1.20 and 1.15, respectively), though the age interaction was not significant ( P = 0.544). Within the plaque population, LDL-C correlated with hypoechoic plaques (OR = 1.23, 95% CI: 1.16–1.30), while the TyG index did not. Conclusion LDL-C and TG/HDL-C exhibit distinct age-modified patterns of association with carotid plaque. The LDL-C association is most pronounced in younger individuals, whereas the TG/HDL-C association remains relatively stable across age strata. These cross-sectional findings generate the hypothesis that age-specific lipid assessment strategies may warrant prospective evaluation.
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Li et al. (2026) conducted a cross-sectional in Carotid plaque (n=21,227). LDL-C vs. Per 1 mmol/L increment was evaluated on Presence of carotid plaque (OR 1.12, 95% CI 1.08-1.17, p=<0.001). Each 1 mmol/L increment in LDL-C (OR 1.12) and 1-unit rise in TG/HDL-C ratio (OR 1.11) were independently associated with increased odds of carotid plaque, with the LDL-C association attenuating with age.
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