To investigate the relationship between low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (LHR) and asymptomatic carotid plaques and their stability in high-risk stroke population.

Between December 2012 and April 2015, a total of 39 944 permanent resident population ≥40 years were used as subjects of the survey from 11 rural communities in Haitou Town, Banzhuang Town and Tashan Town, Ganyu District, and 9 urban communities in Xinpu District and Haizhou District, Lianyungang City using epidemiological survey method of cluster sampling. Excluding those who took lipid-lowering drugs within 3 months and had a history of stroke or transient ischemic attack, 6 592 people at high risk of stroke were finally screened out. Ultrasound was used to detect carotid plaques. The subjects were divided into plaque-free group and plaque group. The latter was further divided into stable plaque group and unstable plaque group. Multivariate logistic regression analysis was used to evaluate the independent risk factor for carotid plaques and their stability. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Receiver Operating Characteristic (ROC) curve was used to evaluate the prediction efficiency of LHR on carotid plaques.

Multivariate logistic regression analysis showed that low-density lipoprotein cholesterol (LDL-C) was an independent risk factor for carotid plaques, while high-density lipoprotein cholesterol (HDL-C) was an independent protection factor of carotid plaques. Using the lowest quintile (Q1) of LHR as a reference, carotid plaque risk increased significantly with the increasing LHR (Q2: OR 1.448, 95% CI 1.082-1.937, P=0.013; Q3: OR 2.414, 95% CI 1.754-3.322, P<0.001; Q4: OR 2.939, 95% CI 1.945-4.441, P<0.001; Q5: OR 4.884, 95% CI 3.143-7.115, P<0.001). ROC curve analysis showed that the area under the curve (AUC) of LHR predicting carotid plaques was 0.795 (95% CI 0.792-0.807; P<0.001), and the optimal cut-off value was 3.00 (sensitivity 68.37%, specificity 75.65%). LHR ≥3.92 (LHR in the Q4 and Q5 subgroups) was an independent risk factor for unstable carotid plaques (OR 2.915, 95% CI 2.104-4.040; P<0.001). The AUC of the LHR predicting unstable carotid plaques was 0.658 (95% CI 0.633-0.684; P<0.001).

LHR was an independent predictor of carotid plaques in high-risk stroke patients. It had higher predictive value for carotid plaques, and its conversion threshold for promoting plaque formation was 3.00. When LHR was ≥3.92, there was a significant increase in the risk of unstable carotid plaques.

Atherosclerosis; Plaque, atherosclerotic; Carotid arteries; Cholesterol, high-density lipoprotein cholesterol; Cholesterol, low-density lipoprotein cholesterol; Biomarkers