Key result
A discordantly high LDL-C/HDL-C ratio with normal total cholesterol significantly increased the risk of elevated carotid intima-media thickness by 54% (HR 1.54) compared to a concordantly low ratio.
Why the study?
Discordance of the LDL-C/HDL-C ratio with alternative lipid parameters may explain the inconsistent association of CIMT with the LDL-C/HDL-C ratio.
Does discordance between the LDL-C/HDL-C ratio and other lipid parameters predict the risk of elevated carotid intima-media thickness in adults without baseline cardiovascular disease?
Cohort (n=13,612)
No
Does discordance between the LDL-C/HDL-C ratio and other lipid parameters predict the risk of elevated carotid intima-media thickness in adults without baseline cardiovascular disease?
Hazard Ratio: 1.54 (95% CI 1.33–1.77)
A high LDL-C/HDL-C ratio acts as a significant risk enhancer for subclinical atherosclerosis (elevated CIMT), even when other lipid parameters like LDL-C or total cholesterol appear normal.
Discordant high LDL-C/HDL-C ratios were associated with elevated CIMT; leaves open whether discordance refines risk stratification beyond standard lipids.
BACKGROUND: The discordance of the low-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio with alterative lipid parameters may explain the inconsistent association of CIMT with the LDL-C/HDL-C ratio. Therefore, this study aimed to explore the associations between LDL-C/HDL-C ratio discordance with alternative lipid parameters and elevated carotid intima-media thickness (CIMT) risk in a large cohort in Beijing, China. METHODS: In total, 13,612 adults who didn't have elevated CIMT at baseline and who participated in at least one follow-up of annual examination between 2009 and 2016 were included in this cohort study. A multivariable Cox regression model was utilized to evaluate the associations of discordance of the LDL-C/HDL-C ratio with TC, TGs, LDL-C and HDL-C with elevated CIMT risk. RESULTS: During 37,999 person-years of follow-up, 2004 individuals (1274 men and 730 women) developed elevated CIMT. Among individuals with normal TC and TGs, 16.6 and 15.2% individuals had a discordantly high LDL-C/HDL-C ratio, respectively, and the risk of elevated CIMT increased by 1.54 (95% CI 1.33, 1.77) and 1.53 (95% CI 1.33, 1.76), respectively, comparing to individuals with a concordantly low LDL-C/HDL-C ratio. A high LDL-C/HDL-C ratio could significantly increase elevated CIMT risk regardless of discordance/concordance with LDL-C and HDL-C (P < 0.001). A low LDL-C/HDL-C ratio with discordantly normal HDL-C and high LDL-C (13.2% of individuals) had a 32% (HR = 1.32, 95% CI 1.11, 1.57) higher risk of elevated CIMT than concordantly low LDL-C and normal HDL-C. Sensitivity analysis by excluding CIMT developed in the first 2 years follow-up further confirmed the above results. CONCLUSIONS: A high LDL-C/HDL-C ratio could significantly increase elevated CIMT risk regardless of discordance/concordance with TC, TGs, LDL-C and HDL-C Even a low LDL-C/HDL-C ratio with discordantly high LDL-C and normal HDL-C could also significantly increase CIMT risk. Individuals should maintain both the LDL-C/HDL-C ratio and LDL-C at normal levels to prevent elevated CIMT.
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Lou et al. (2020) conducted a cohort in Elevated carotid intima-media thickness (CIMT) (n=13,612). Discordantly high LDL-C/HDL-C ratio with normal total cholesterol vs. Concordantly low LDL-C/HDL-C ratio was evaluated on Elevated carotid intima-media thickness (CIMT ≥1 mm) (HR 1.54, 95% CI 1.33, 1.77). A discordantly high LDL-C/HDL-C ratio with normal total cholesterol significantly increased the risk of elevated carotid intima-media thickness by 54% (HR 1.54) compared to a concordantly low ratio.
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