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Serum Cholesterols Have a More Important Role Than Triglycerides in Determining Intima-Media Thickness of the Common Carotid Artery in Subjects Younger Than 55 Years of Age

Departments of Neurology (M.T.M., L.C., D.B.) and Internal Medicine (G.P., E.K., I.S.), Health Science and Medical Center, University of Debrecen, Debrecen, Hungary; and Department of Neurology, County Hospital, Miskolc, Hungary (A.V.).

Address correspondence and reprint requests to Dániel Bereczki, MD, PhD, DHAS, Department of Neurology, Health Science and Medical Center, University of Debrecen, Nagyerdei korut 98, H-4012 Debrecen, Hungary. E-mail: bereczki{at}jaguar.dote.hu.

Objective. The role of serum cholesterol and triglycerides in carotid artery atherosclerosis is controversial. We measured carotid artery intima-media thickness (IMT), a marker of atherosclerosis in subjects younger than 55 years of age with a 6-fold range of serum cholesterol levels (3.93–25.03 mmol/L) and a 200-fold range of triglyceride levels (0.36–75.97 mmol/L). Methods. Eighty-six patients with increased serum lipid values and 30 subjects with normal lipid values were included. Serum lipids were measured after an overnight fast. High-resolution sonographic investigations of the carotid arteries of all patients were videotaped. Intima-media thickness was measured offline at 1-mm increments in the distal 10-mm segments of both common carotid arteries by a reader blinded to patient characteristics. First, IMT was compared among groups defined by their cholesterol and triglyceride levels with the use of traditional cutoff values. Next, all subjects were pooled, and general regression analysis was performed to identify significant predictors of IMT with age, body mass index, lipid values, sex, diabetes, hypertension, and smoking status as independent variables. Results. Intima-media thickness was larger in patient groups with high cholesterol levels (ie, the hypercholesterolemic and combined hyperlipidemic groups) than in the control, borderline, and isolated hypertriglyceridemic groups (P < .01). In the general multiple regression model, IMT correlated positively with total cholesterol level (ß = 0.343; P = .002) and age (ß = 0.3; P = .006) but not with triglyceride level. Conclusions. Both the group comparisons and the general regression analysis of the pooled data suggest that hypercholesterolemia has an important role in early onset IMT changes in the common carotid artery, whereas hypertriglyceridemia does not have an appreciable role.

Key Words: atherosclerosis • cholesterol • intima-media thickness • triglycerides

Abbreviations: ANOVA, analysis of variance • BMI, body mass index • CCA, common carotid artery • CI, confidence interval • HDL-C, high-density lipoprotein cholesterol • IMT, intima-media thickness • IMT_blind, IMT readings by an independent reader blinded to the characteristics of study subjects • LDL-C, low-density lipoprotein cholesterol

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