The Cumulative Atherogenic Index of Plasma Exposure in Carotid Plaque: A Cohort Study in China

Atherogenic index of plasma (AIP) is recognized as a marker for atherosclerosis, but the impact of long-term AIP exposure on carotid plaque remains unknown.

The objective of the study is to assess the associations of cumulative AIP (cumAIP), incorporating the time course of cumAIP accumulation with the risk of carotid plaque.

A total of 9,202 participants from the Beijing Health Management Cohort were followed up until December 31, 2021. AIP was calculated as the logarithm of the ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C). CumAIP was derived by averaging AIP values between consecutive visits and multiplying by time intervals. HRs and 95% CIs were calculated using an adjusted Cox proportional hazards model to examine the association between AIP and carotid plaque. Discordance analysis of cumAIP vs TG and HDL-C was performed using the median as the cutoff. External validation was conducted using data from the Atherosclerosis Risk in Communities study.

During a median follow-up of 3.99 years, 2,879 participants developed carotid plaque. The highest quartile of cumAIP was significantly associated with an increased risk of carotid plaque (HR: 1.55; 95% CI: 1.36-1.76). Both low TG/high cumAIP group (HR: 1.26; 95% CI: 1.10-1.45) and high HDL-C/high cumAIP group (HR: 1.23; 95% CI: 1.09-1.39) also showed an elevated risk for carotid plaque.

CumAIP independently increased the risk of carotid plaque. Discordantly high cumAIP, rather than TG or HDL-C alone, poses a greater risk. Maintaining healthy AIP levels over time may be crucial for preventing atherosclerotic disease.