PubMedFrontiers in cardiovascular medicine2026-08-04
Differential age-related patterns in the associations of LDL-C, TG/HDL-C ratio, and carotid plaque: a large-scale cross-sectional study in a Chinese health check-up population.
Li Zeda Z, Zhu Biqiong B, Chen Kui K, Long Xiangdang X et al.
While the associations of low-density lipoprotein cholesterol (LDL-C) and the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C) with carotid atherosclerosis are known, their age-varying trajectories remain unclear. This study aimed to characterize the age-specific heterogeneity in these associations using a large Chinese health check-up cohort.
We retrospectively enrolled 23,058 adults undergoing carotid ultrasonography. After exclusions, 21,227 participants were included. Multivariate logistic regression evaluated the independent associations of LDL-C and TG/HDL-C with carotid plaque. Age-stratified analyses (<40, 40-49, 50-59, 60-69, ≥70 years) and interaction tests were performed. Sensitivity analyses included substituting non-HDL-C for LDL-C and the triglyceride-glucose index (TyG index) for TG/HDL-C. Associations with hypoechoic plaques were also assessed.
The carotid plaque detection rate was 31.4% (6,657/21,227). Both LDL-C (OR = 1.12, 95% CI: 1.08-1.17, P < 0.001) and TG/HDL-C (OR = 1.11, 95% CI: 1.07-1.15, P < 0.001) were independently associated with plaque. However, their age patterns diverged significantly. The association of LDL-C was strongest in participants aged <40 years (OR = 1.51, 95% CI: 1.30-1.76) but attenuated with age, becoming non-significant in those ≥60 years (P for interaction <0.001). Conversely, the TG/HDL-C association remained stable across age groups, with the numerically highest ORs observed in the <40 and 50-59 age groups (OR = 1.20 and 1.15, respectively), though the age interaction was not significant (P = 0.544). Within the plaque population, LDL-C correlated with hypoechoic plaques (OR = 1.23, 95% CI: 1.16-1.30), while the TyG index did not.
LDL-C and TG/HDL-C exhibit distinct age-modified patterns of association with carotid plaque. The LDL-C association is most pronounced in younger individuals, whereas the TG/HDL-C association remains relatively stable across age strata. These cross-sectional findings generate the hypothesis that age-specific lipid assessment strategies may warrant prospective evaluation.