Influence of Persistently Elevated LDL Values on Carotid Intima Media Thickness in Elite Athletes

Carotid IMT is a recognized marker for early atherosclerotic changes and a predictor of future CV events. Previous studies showed 11% increased risk of myocardial infarction with each 0.1 mm incremental increase of carotid IMT. In general population, LDL cholesterol levels are positively correlated with carotid IMT in both cross-sectional and longitudinal studies while its role in elite athletes remains understudied.

This study aimed to investigate the correlation between persistent lipid profile alterations and early markers of atherosclerosis, specifically carotid IMT, in a cohort of elite athletes.

We included 302 athletes serially evaluated for a prolonged time period. Anthropometric data, blood tests for lipid profiles, and carotid IMT measurements were collected. Dyslipidemia was defined as LDL ≥ 116 mg/dL, and persistent elevation when LDL values remained above the threshold limits in at least three pre-participation screenings. Categorical variables were expressed as frequencies and percentages and were compared using Fisher's exact test or Chi-square test, as appropriate.

91 athletes (30.1%) had persistently elevated LDL levels. Dyslipidemic athletes were older (30.7 ± 5.7 vs. 29.1 ± 4.1 years, p = 0.008), had higher BMI (p = 0.032), and a higher prevalence of obesity (5.5% vs. 0.5%, p = 0.004) compared to those with normal lipid profiles. Additionally, they had higher total cholesterol (p < 0.0001) and triglycerides (p < 0.0001) but similar HDL levels (p = 0.213). Globally, athletes with altered LDL profiles over long-time period showed higher IMT (0.60 ± 0.10 mm vs. 0.57 ± 0.07 mm, p = 0.014). In particular, longer exposure to elevated LDL was significantly associated with increased IMT (0.61 ± 0.12 mm vs. 0.57 ± 0.06 mm, p = 0.035).

Our study highlights the association between persistently elevated LDL-C and increased carotid IMT in elite athletes, with longer exposure time correlating with more pronounced carotid changes. These findings underscore the importance of regular monitoring of blood lipid profiles and carotid IMT measurements as a non-invasive, cost-effective method to prevent atherosclerotic vascular disease.