Abstract
BackgroundEvidence on the relationship between the low−/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) and carotid plaques remains limited. This study aimed to examine the association between LDL-C/HDL-C and carotid plaques in participants with coronary heart disease (CHD) and to further explore the extent to which a healthy lifestyle reduces the risk of LDL-C/HDL-C-related carotid plaques.MethodsThis large-scale and multi-centre retrospective study included 9426 CHD patients (aged 35–75 years) between January 1, 2014 and September 30, 2020. The LDL-C/HDL-C values were converted to the following tertiles: lowest (< 2.15), middle (2.15–3), and highest (> 3). Healthy lifestyle-related factors referred to whether or not the participant was a non-smoker and non-drinker. Participants were divided into an unfavourable group (those who did not adhere to healthy lifestyle factors), intermediate (only one unhealthy factor), and favourable (neither of the two unhealthy factors). Logistic regression was used for statistical analyses.ResultsOf the 9426 participants, 6989 (74.15%) CHD patients had carotid plaques. After adjustment for confounders, each unit increase in the LDL-C/HDL-C was significantly associated with carotid plaques (OR: 1.61; 95%CI: 1.43–1.84; P < 0.001). Multivariate logistic regression revealed that carotid plaques risk for the highest tertile (> 3) was 1.18 times that of the lowest quartile (< 2.15). Compared with an unfavourable lifestyle, an intermediate or a favourable lifestyle was associated with a significant 30% (OR: 0.70; 95%CI: 0.64–0.78; P < 0.001) or 67% (OR: 0.33; 95%CI: 0.29–0.37; P < 0.001) reduction in carotid plaques risk, respectively, among CHD patients with high LDL-C/HDL-C. There were significantly additive and multiplicative interactions between lifestyle and LDL-C/HDL-C with regards to carotid plaques.ConclusionA high LDL-C/HDL-C is associated with a risk of carotid plaques developing in CHD patients. Adhering to a healthy lifestyle has additive beneficial effects on reducing the risk of carotid plaques, especially in relation to the highest LDL-C/HDL-C.Graphical abstract
Highlights
The statistical report of the American Heart Association, updated in 2021, indicates that cardiovascular disease is associated with a substantial global health and economic burden [1]
It has been reported that when the conventional lipid parameters of triglycerides (TG), namely high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) remain apparently normal, other lipid parameters, such as lipid ratios, including TC/HDL-C, LDL-C/HDL-C, TG/HDLC, and non-HDL-C/HDL-C, are the diagnostic alternatives that predict the risk of a cardiovascular event [3,4,5]
Baseline characteristics Of the 9426 participants, the average age was 59.00 ± 5.00 years, males constituted 48.96%, and coronary heart disease (CHD) patients with carotid plaques accounted for 74.15%
Summary
The statistical report of the American Heart Association, updated in 2021, indicates that cardiovascular disease is associated with a substantial global health and economic burden [1]. Studies have shown that peripheral vascular AS is predictive of cardiovascular diseases (CVD) with the highest mortality rates. Clinical studies have suggested that despite treatment to reduce LDL-C, significant major adverse cardiovascular events may continue to occur, and may be residual risks associated with lipid abnormalities, dyslipidaemia causing AS [6, 7]. Previous studies have shown that high LDL-C/HDL-C is associated with an increased risk of carotid plaque in obese adults [8]. Evidence on the relationship between the low−/high-density lipoprotein cholesterol ratio (LDL-C/ HDL-C) and carotid plaques remains limited. This study aimed to examine the association between LDL-C/HDL-C and carotid plaques in participants with coronary heart disease (CHD) and to further explore the extent to which a healthy lifestyle reduces the risk of LDL-C/HDL-C-related carotid plaques
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