Letter: Atherosclerotic Carotid Artery Disease Evaluation and Blood Lipids

Dear editor,

We read with interest the paper by Liu et al ¹ entitled “Relationship Between Total Cholesterol/ High-Density Lipoprotein Cholesterol and Carotid Artery Plaque in Ischemic Stroke Patients Based on Sex and Age.” We congratulate the authors. However, some issues about atherosclerotic cardiovascular disease and Total Cholesterol to High-Density Lipoprotein Cholesterol (TC/HDL-C) ratio should be clarified.

Hyperlipidemia is known to play a significant role in the development and prognosis of atherosclerotic cardiovascular disease. In this context, a recent study has shown that TC/HDL-C values are significantly associated with the presence and number of carotid artery plaques. ¹ The main idea of this study is based on atherosclerotic plaque and lipid disorders. However, information on other vascular system diseases of the patients is not available in the study. ¹ We consider this a significant limitation. Peripheral vascular plaque structures, coronary vascular plaques, and intracranial plaques may have affected TC/HDL-C values. A clinical study involving healthy men and women demonstrated an association with coronary artery disease. ² In studies investigating the relationship between elevated TC/HDL-C and atherosclerotic plaque, it would be beneficial to assess the plaque burden in the entire cardiovascular system.

A study conducted on a large patient series retrospectively examined patients over approximately 10 years. Carotid artery evaluations were performed with Doppler ultrasonography (DUSG) in all patients. ¹ The fact that these DUSG evaluations were performed by many different physicians over a 10-year period may have led to differences in evaluations. The evaluation of carotid arteries by DUSG is a highly specific procedure and is person-dependent. In this study, which included patients with ischemic stroke, a comparison of the findings of carotid computed tomography angiography (CCTA) with TC/HDL-C may be more objective. CCTA evaluations can yield more objective findings of carotid artery structures, such as the necrotic core area, necrotic core percentage, dense calcium area, and total atherosclerotic burden. ³