Pierre-Jean Touboul1, Julien Labreuche2, Eric Bruckert3, Herman Schargrodsky4, Patrizio Prati5, Alberto Tosetto6, Rafael Hernandez-Hernandez7, Kam-Sang Woo8, Honorio Silva9, Eric Vicaut10, Pierre Amarenco11. 1. From INSERM U 698, Paris, France; Paris Diderot - Sorbonne Paris City University, Paris, France; Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: pjtw@Noos.Pa. 2. From INSERM U 698, Paris, France; Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France. 3. Department of Endocrinology, Pitié-Salpêtrière University Hospital, Pierre and Marie Curie University, Paris, France. 4. Department of Cardiology, Buenos Aires Italian Hospital, Buenos Aires, Argentina. 5. Department of Neurology, "Gervasutta" Hospital ASS 4, Udine, Italy. 6. Department of Hematology, S. Bortolo Hospital, Vicenza, Italy. 7. Hypertension and Cardiovascular Risk Factors Clinic, Clinical Pharmacology Unit, School of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, Venezuela. 8. School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China. 9. Department of Cardiology, Buenos Aires Italian Hospital, Buenos Aires, Argentina; InterAmerican Foundation for Clinical Research, New York, USA. 10. Paris Diderot - Sorbonne Paris City University, Paris, France; Department of Biostatistics, Fernand Widal Hospital, Paris, France. 11. From INSERM U 698, Paris, France; Paris Diderot - Sorbonne Paris City University, Paris, France; Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: pierre.amarenco@bch.aphp.fr.
Abstract
OBJECTIVE: Common carotid artery (CCA) intima-media thickness (IMT), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), but not triglyceride levels, are markers of future cardiovascular events. The relationship between these three factors is, however, unclear. METHODS: We included six large observational studies that used the same harmonized, B-mode ultrasound protocol, the same software for IMT measurement by automatic edge detection on CCA in a plaque-free region, following the Mannheim consensus, and certification of all sonographers. Using the best view of the CCA, the sonographer had to confirm that the quality index was ≥ 0.5 on a measurement performed on 10-mm length. We used individual data meta-analysis to estimate the cross-sectional associations of lipids with CCA-IMT. RESULTS: Overall, 21,587 patients with complete information on lipids and CCA-IMT were available. Age- and sex-adjusted CCA-IMT differed by -7.8 μm (95% CI -9.1 to -6.5 μm, P < 0.001) per 1 SD higher HDL-C level. After further adjustment for other atherosclerosis risk factors, the relationship was attenuated, but remained significant (regression coefficient, -3.7 μm; P < 0.001). This was found regardless of LDL-C levels (P for heterogeneity = 0.70). After adjustment for age and sex, triglycerides were positively associated with CCA-IMT, overall and in each LDL-C subgroup, but not after further adjustments for other risk factors. CONCLUSIONS: Relationships between HDL-C and triglyceride levels and CCA-IMT were consistent with that previously observed with clinical events by the Emergency Risk Collaboration group, including at low LDL-C levels. This reinforces the need to verify whether raising HDL-C levels decreases both CCA-IMT and future clinical events.
OBJECTIVE: Common carotid artery (CCA) intima-media thickness (IMT), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), but not triglyceride levels, are markers of future cardiovascular events. The relationship between these three factors is, however, unclear. METHODS: We included six large observational studies that used the same harmonized, B-mode ultrasound protocol, the same software for IMT measurement by automatic edge detection on CCA in a plaque-free region, following the Mannheim consensus, and certification of all sonographers. Using the best view of the CCA, the sonographer had to confirm that the quality index was ≥ 0.5 on a measurement performed on 10-mm length. We used individual data meta-analysis to estimate the cross-sectional associations of lipids with CCA-IMT. RESULTS: Overall, 21,587 patients with complete information on lipids and CCA-IMT were available. Age- and sex-adjusted CCA-IMT differed by -7.8 μm (95% CI -9.1 to -6.5 μm, P < 0.001) per 1 SD higher HDL-C level. After further adjustment for other atherosclerosis risk factors, the relationship was attenuated, but remained significant (regression coefficient, -3.7 μm; P < 0.001). This was found regardless of LDL-C levels (P for heterogeneity = 0.70). After adjustment for age and sex, triglycerides were positively associated with CCA-IMT, overall and in each LDL-C subgroup, but not after further adjustments for other risk factors. CONCLUSIONS: Relationships between HDL-C and triglyceride levels and CCA-IMT were consistent with that previously observed with clinical events by the Emergency Risk Collaboration group, including at low LDL-C levels. This reinforces the need to verify whether raising HDL-C levels decreases both CCA-IMT and future clinical events.
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