Front Med (Lausanne). 2026 Feb 17;13:1771449. doi: 10.3389/fmed.2026.1771449. eCollection 2026.
ABSTRACT
BACKGROUND: Atherosclerotic cardiovascular and cerebrovascular diseases are still the main cause of global incidence rate and mortality. The LDL-C/HDL-C ratio (LHR) has been identified as a potential biomarker for cardiovascular risk. However, the relationship between it and the long-term risk of carotid plaques is not yet clear, especially in low-income populations in China.
METHODS: This prospective cohort study included adults aged ≥45 years without carotid plaque at baseline from low-income rural areas of Tianjin, China. Baseline characteristics were collected in 2014, and follow-up data were obtained in 2019. The primary outcome was the development of new carotid plaques, assessed using carotid ultrasound. The relationship between the LDL-C/HDL-C ratio (LHR) and new carotid plaques was analyzed using multifactorial logistic regression, with the presence or absence of new-onset plaques as the dependent variable. Additionally, we utilized restricted cubic spline (RCS) regression to visually present the potential nonlinear relationship between LHR and the risk of carotid plaque.
RESULTS: Over the six-year follow-up period, 606 participants (38.3%) developed new carotid plaques. Higher LHR was significantly associated with an increased risk of new carotid plaques, with each unit increase in LHR corresponding to a 35.9% higher risk (OR = 1.359, 95% CI: 1.180-1.566, p < 0.001). The RCS curve indicated a non-linear positive association between LHR and the likelihood of carotid plaques (p for non-linearity = 0.019), with an optimal cut-off at 1.257. Logistic regression analysis confirmed that LHR > 1.257 was linked to increased odds of carotid plaques in both unadjusted (OR: 1.80, p < 0.001) and adjusted models (OR: 1.835, p < 0.001), with LHR ≤ 1.257 serving as the reference. In subgroup analysis, all subgroups consistently demonstrated a significant association between increased LHR (all OR > 1).
CONCLUSION: The research results indicate that there is a non-linear positive correlation between LHR and the long-term risk of carotid plaques in middle-aged and elderly populations, suggesting that LHR may be an effective indicator for screening carotid plaques in grassroots middle-aged and elderly populations.
PMID:41783061 | PMC:PMC12953421 | DOI:10.3389/fmed.2026.1771449