Carotid Atherosclerosis, Ultrasound and Lipoproteins

Abstract

Carotid artery plaques are considered a measure of atherosclerosis and are associated with an increased risk of atherosclerotic cardiovascular disease, particularly ischemic strokes. Monitoring of patients with an elevated risk of stroke is critical in developing better prevention strategies. Non-invasive imaging allows us to directly see atherosclerosis in vessels and many features that are related to plaque vulnerability. A large body of evidence has demonstrated a strong correlation between some lipid parameters and carotid atherosclerosis. In this article, we review the relationship between lipids and atherosclerosis with a focus on carotid ultrasound, the most common method to estimate atherosclerotic load.

Clinical Significance of Carotid Intima-Media Complex and Carotid Plaque Assessment by Ultrasound for the Prediction of Adverse Cardiovascular Events in Primary and Secondary Care Patients

“…There is much confusion with regard to lipoproteins and CIMT. Single-center studies indicate the relationship between higher CIMT and higher levels of total cholesterol (TC), LDL-C, lipoprotein (a), and non-HDL-cholesterol, as well as inverse associations with HDL-C; however, meta-analyses fail to show associations [ 62 , 85 , 86 , 87 , 88 , 89 ]. For example, in a study by Stamler et al in a group of men aged 18 to 39 years, those with TC levels ≥ 6.21 mmol/L had a greater risk of CHD (2.15 to 3.63 times) and CV mortality (2.10 to 2.87 times) in comparison to individuals with TC < 5.17 mmol/L [ 90 ].…”

Immunity in Atherosclerosis: Focusing on T and B Cells

“…An essential correlation was spotted between TEM and total plasma cholesterol, as well as LDL cholesterol. Despite the link between TEM and carotid artery atherosclerosis, there was no dependence on the classical cardiovascular risk factors, which proves the validity of the adaptive immune response in cardiovascular disorders [42]. After the removal of the antigen that triggered the immune response, TEM cells and central memory T cells (TCM) are stored in the memory pool.…”

Association between Non-HDL-C/HDL-C Ratio and Carotid Intima–Media Thickness in Post-Menopausal Women

“…For these reasons, we could not use strong end points (mortality, myocardial infarction, stroke) that may only be available in a prospective study, and were therefore forced to use surrogate end points such as subclinical atherosclerosis studied using ultrasound. However, this method represents an excellent proxy for generalized atherosclerosis [ 30 , 31 ]. Moreover, another limitation of the study is the use of the Friedewald formula for the calculation of LDL-C instead of a direct measurement of LDL-C.…”

“…The use of Friedewald formula could lead to underestimation of LDL-C, especially in patients with low LDL-C concentration (<100 mg/dL) and/or high triglycerides levels (>200 mg/dL). Conversely, strengths of the study include the use of a solid and validated ultrasound protocol for studying atherosclerosis [ 32 ] and the availability of biochemical parameters of lipid and glycaemic metabolism not routinely measured (i.e., apo-B, lipid subfractions, insulin) [ 31 ].…”