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Carotid atherosclerosis in men with low levels of HDL cholesterol
T J Wilt1, H B Rubins, S J Robins
1Section of General Internal Medicine, Minneapolis Veterans Affairs (VA) Medical Center, Minneapolis, MN 55417, USA. wilt,timothy@minneapolis.va.gov
Insights
Men with low HDL cholesterol and coronary heart disease but normal LDL cholesterol have high rates of carotid atherosclerosis. This finding highlights the importance of assessing carotid artery health in this patient group.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Diagnostic Imaging
Background:
- Low high-density lipoprotein cholesterol (HDL-C) is a risk factor for coronary heart disease (CHD).
- Carotid atherosclerosis independently predicts morbidity and mortality in CHD patients.
- This study focuses on men with low HDL-C and CHD but normal LDL-C and total cholesterol.
Purpose of the Study:
- To determine the prevalence of carotid atherosclerosis in men with low HDL-C and CHD.
- To identify correlates of sonographically detected carotid atherosclerosis in this population.
Main Methods:
- High-resolution B-mode ultrasonography used to measure intima-media thickness (IMT) and carotid artery stiffness.
- Study included 202 male veterans with CHD and low HDL-C from the VA HDL Intervention Trial.
- Carotid IMT quantified in common, internal, and bifurcation segments.
Main Results:
- Prevalence of carotid atherosclerosis was high: 58.9% (mean max IMT ≥ 1.3 mm) and 87.1% (single max IMT ≥ 1.5 mm).
- Intima-media thickness correlated with increased age, lower extremity arterial disease, systolic blood pressure, and carotid artery stiffness.
- Mean maximum and single greatest IMT measurements were 1.41 mm and 2.58 mm, respectively.
Conclusions:
- Men with low HDL-C and CHD, despite normal LDL-C, exhibit a very high prevalence of carotid artery atherosclerosis.
- Findings underscore the significance of subclinical atherosclerosis in this specific patient demographic.
Background And Purpose:
A low HDL cholesterol (HDL-C) frequently occurs in conjunction with a desirable LDL cholesterol (LDL-C) and is a risk factor for coronary heart disease (CHD). Additionally, the presence of carotid atherosclerosis is a strong and independent predictor of morbidity and mortality in patients with CHD. This article describes the prevalence and correlates of sonographically detected carotid atherosclerosis in men with low levels of HDL-C and CHD but without elevated levels of LDL-C or total cholesterol.
Methods:
High-resolution B-mode ultrasonography was used to quantify intima-media wall thickness (IMT) in the common and internal carotid arteries and at the carotid artery bifurcation in 202 randomly selected male veterans with CHD and low levels of HDL-C who are participating in the VA HDL Intervention Trial. Ultrasonographic measurement of carotid artery wall stiffness was determined in a subset of 94 of these individuals.
Results:
The mean maximum and single greatest carotid artery IMT measurements were 1.41 and 2.58 mm, respectively. The prevalence of ultrasound-detected carotid atherosclerosis as defined by a mean maximum IMT > or = 1.3 mm was 58.9% and by single maximum IMT > or = 1.5 mm was 87.1%. IMT was associated with increased age, lower extremity arterial disease, systolic blood pressure, and ultrasonographically measured carotid artery stiffness.
Conclusions:
Men with low levels of HDL-C and CHD but without elevated LDL-C or total cholesterol have a very high prevalence of ultrasound-detected carotid artery atherosclerosis.