Association of triglyceride-driven residual atherosclerotic risk with carotid stiffening assessed using ultrafast ultrasound imaging in individuals with hypertriglyceridemia.

Abstract

Purpose: Patients with hypertriglyceridemia retain residual atherosclerotic risk despite achieving low-density lipoprotein cholesterol (LDL-C) targets. This study investigated the association of this risk with carotid stiffening assessed by ultrafast pulse wave velocity (ufPWV).

Methods: This study included 518 participants who underwent simultaneous ufPWV and carotid intima-media thickness (cIMT) measurements. Participants were stratified by triglyceride (TG) level into TG-optimal, TG-normal, and TG-high groups. Pulse wave velocity (PWV) at the beginning of systole and at the end of systole (PWV-ES) were measured using ufPWV. Participants were also categorized by Framingham risk score (FRS) into low-, intermediate-, and high-risk subgroups and by LDL-C level into normal and high subgroups. Logistic regression analysis was used to evaluate the potential predictive role of increased PWV-ES.

Results: In the total population and the normal LDL-C subgroup, both the TG-high and TG-normal groups had higher PWV-ES and cIMT values than the TG-optimal group (all P<0.05). Among participants with normal cIMT (<0.050 cm), PWV-ES effectively differentiated the TG-optimal and TG-high groups (P<0.001), but this difference was not observed when cIMT was ≥0.050 cm. Similarly, PWV-ES differentiated TG groups within the low-risk FRS subgroup (all P<0.01), but not within the intermediate- or high-risk subgroups. Logistic regression showed that increased PWV-ES was independently associated with high TG levels in both the normal LDL-C subgroup (odds ratio [OR], 1.21; P=0.006) and the high LDL-C subgroup (OR, 1.57; P=0.023) after adjustment for LDL-C alone.

Conclusion: ufPWV-quantified carotid stiffness is associated with elevated TG-driven residual atherosclerotic risk, independent of LDL-C.