Effect of lipid parameters on carotid artery disease progression in patients undergoing carotid endarterectomy and unoperated patients with non-severe carotid artery stenosis

Year 2019, , 159 - 165, 04.01.2019

Kadir Kaan Özsin , Umut Serhat Sanrı , Faruk Toktaş , İbrahim Burak Şeker Şenol Yavuz

https://doi.org/10.18621/eurj.444384

Abstract

Objectives: We
aim to evaluate the relationship between serum lipid indices and carotid artery
stenosis (CAS).

Methods: This
retrospective observational study included patients who underwent carotid
endarterectomy (CEA) and unoperated patients who have CAS less than 50%. CAS
was diagnosed with history and physical examination followed by doppler ultrasonography,
coronary and carotid angiography. All data retrieved retrospectively from the
hospital medical files. Non-high-density lipoprotein-cholesterol (non-HDL-C)
level was calculated by removing HDL-C from total cholesterol. In addition,
low-density lipoprotein-cholesterol (LDL-C)/HDL-C ratio, non-HDL-C/HDL-C ratio,
and triglyceride (TG)/HDL-C ratio were assessed.

Results: CEA group
(77.5% male, mean age: 71.35 ± 8.35 years) included 40 patients who underwent CEA,
and there were 32 patients who have less than 50% CAS in unoperated group (68.8%
male, mean age: 63.94 ± 9.92 years). The development of CAS was not
significantly correlated with LDL-C/HDL-C ratio (p = 0.119), non-HDL-C/HDL-C ratio (p = 0.227) and TG/HDL-C ratio (p
= 0.768). Advanced age and presence of coronary artery disease were
identified as an independent predictor of the development of CAS. For
predicting development of CAS, there were 50.0% sensitivity and 65.6%
specificity for LDL-C/HDL-C ratio and non-HDL-C/ HDL-C ratio (area under the
curve [AUC]: 0.592, log rank p = 0.183,
AUC: 0.583, log rank p = 0.227,
respectively).

Conclusions: We
found that lipid ratios were not an independent predictors of the development
of CAS. But, we think that AUC values which were above 0.5 for lipid ratios are
may be important development of CAS. 

Keywords

Carotid artery stenosis, lipid levels, disease progression

References

• [1] Boulos NM, Gardin JM, Malik S, Postley J, Wong ND. Carotid plaque characterization, stenosis, and intima-media thickness according to age and gender in a large registry cohort. Am J Cardio 2016;117:1185-91.
• [2] Toktas F, Goncu T, Surer S, Yumun G, Ozsin KK, Erdolu B, et al. Carotid endarterectomy: a comparison on general and local anesthesia. Eur Res J 2015;1:39-43.
• [3] Divya KP, Sandeep N, Sarma S, Sylaja PN. Risk of stroke and cardiac events in medically treated asymptomatic carotid stenosis. J Stroke Cerebrovasc Dis 2015;24:2149-53.
• [4] Wong BW, Meredith A, Lin D, McManus BM.The biological role of inflammation in atherosclerosis. Can J Cardiol 2012;28:631-41.
• [5] Anitschkow N, Chalatow S. Pelias, Mary Z. Classics in arteriosclerosis research: On experimental cholesterin steatosis and its significance in the origin of some pathological processes. Arteriosclerosis 1983;3:178-82.
• [6] Fine-Edelstein JS, Wolf PA, O’Leary DH, Poehlman H, Belanger AJ, Kase CS, et al. Precursors of extracranial carotid atherosclerosis in the Framingham study. Neurology 1994;44:1046-50.
• [7] Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.
• [8] Van den Munckhof ICL, Jones H, Hopman MTE, de Graaf J, Nyakayiru J, van Dijk B, et al. Relation between age and carotid artery intima-medial thickness: a systematic review. Clin Cardiol 2018;41:698-704.
• [9] Youn YJ, Lee NS, Kim JY, Lee JW, Sung JK, Ahn SG, et al. Normative values and correlates of meancommon carotid intima-media thickness in the Korean rural middle-aged population: the Atherosclerosis Risk of Rural Areas in Korea General Population (ARIRANG) study. J Korean Med Sci 2011;26:365-71.
• [10] Engelen L, Ferreira I, Stehouwer CD, Boutouyrie P, Laurent S. Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors. Eur Heart J 2013;34:2368-80.
• [11] Yokokawa H, Yasumura S, Tanno K, Ohsawa M, Onoda T, Itai K, et al. Serum low-density lipoprotein to high-density lipoprotein ratio as a predictor of future acute myocardial infarction among men in a 2.7-year cohort study of a Japanese northern rural population. J Atheroscler Thromb 2011;18:89-98.
• [12] National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment ofhigh blood cholesterol in adults (adult treatment panel III) final report. Circulation 2002;106:3143-421.
• [13] Cui Y, Blumenthal RS, Flaws JA, Whiteman MK, Langenberg P, Bachorik PS, et al. Non-high density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med 2001;161:1413-9.
• [14] Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. JAMA 2005;294:326-33.
• [15] Kinosian B, Glick H, Garland G. Cholesterol and coronary heart disease: predicting risks by levels and ratios. Ann Intern Med 1994;121:641-7.
• [16] Zhou M, Zhu L, Cui X, Feng L, Zhao X, He S, et al. The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio as a predictor of insülin resistance but not of β cell function in a Chinese population with different glucose tolerance status. Lipids Health Dis 2016;15:104.
• [17] Kiyosue A. Nonfasting TG/HDL-C ratio seems a good predictor of MACE in CAD patients with statin therapy. Could it be a treatment target? J Cardiol 2018;71:8-9.
• [18] Bittner V, Hardison R, Kelsey SF, Weiner BH, Jacobs AK, Sopko G. Non-high-density lipoprotein cholesterol levels predict five-year outcome in the bypass angioplasty revascularization investigation (BARI). Circulation 2002;106:2537-42.
• [19] Emerging Risk Factors Collaboration, Di Angelantonio E, Sarwar N, Perry P, Kaptoge S, Ray KK, Thompson A, et al. Major lipids, apolipoproteins, and risk of vascular disease. JAMA 2009;302:1993-2000.
• [20] Hou Q, Li S, Gao Y, Tian H. Relations of lipid parameters, other variables with carotid intima-media thickness and plaque in the general Chinese adults: an observational study. Lipids Health Dis 2018;17:107.
• [21] Siemelink MA, van der Laan SW, van Setten J, de Vries JP, de BorstGJ, Moll FL, et al. Common variants associated with blood lipid levels do not affect carotid plaque composition. Atherosclerosis 2015;242:351-6.
• [22] Ibrahimi P, Jashari F, Bajraktari G, Wester P, Henein MY. Ultrasound assessment of carotid plaque echogenicity response to statin therapy: a systematic review and meta-analysis. Int J Mol Sci 2015;16:10734-47.