Abstract
BackgroundThe 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.MethodsIn 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.ResultsDuring 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.ConclusionsA 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.
Highlights
Carotid intima-media thickness (CIMT), an alternative indicator of subclinical atherosclerosis, can predict future ischemic cardiovascular disease (CVD) and stroke events [1,2,3,4,5]
Discordance of the Low-density lipoprotein cholesterol (LDL-C)/High-density lipoprotein cholesterol (HDL-C) ratio with total cholesterol (TC), and TGs and elevated carotid intima-media thickness (CIMT) risk Among individuals with normal TC, 16.6% of individuals had a discordantly high LDL-C/HDL-C ratio, with a 54% (HR = 1.54, 95% confidence intervals (CIs) 1.33–1.77) higher risk of elevated CIMT than that among individuals who had a concordantly low ratio of LDL-C/HDL-C according to model 3
There is no significant association between a low ratio of LDL-C/HDL-C with discordantly high TC (20.2% individuals) and elevated CIMT risk
Summary
Carotid intima-media thickness (CIMT), an alternative indicator of subclinical atherosclerosis, can predict future ischemic cardiovascular disease (CVD) and stroke events [1,2,3,4,5]. Low-density lipoprotein cholesterol (LDL-C) is atherogenic and a dominating target of lipid-lowering treatment [7]. Previous studies have reported significant association of CIMT with the LDL-C/HDL-C ratio [12, 13]. 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 LDLC/HDL-C ratio. 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
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