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(Stroke. 1997;28:1919-1925.)
© 1997 American Heart Association, Inc.

Articles

Carotid Atherosclerosis in Men With Low Levels of HDL Cholesterol

Timothy J. Wilt, MD, MPH; Hanna B. Rubins, MD, MPH; Sander J. Robins, MD; Ward A. Riley, PhD; Dorothea Collins, ScD; Marshall Elam, MD, PhD; Gale Rutan, MD, MPH; James W. Anderson, MD

From the Section of General Internal Medicine and Department of Medicine, Minneapolis Veterans Affairs (VA) Medical Center and University of Minnesota School of Medicine, Minneapolis (T.J.W., H.B.R.); Department of Neurology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC (W.A.R.); Section of Lipid Metabolism and Department of Medicine, Boston VA Medical Center and Boston University School of Medicine (Mass) (S.J.R.); VA Cooperative Studies Coordinating Center, West Haven VA Medical Center (Conn) (D.C.); Section of Endocrinology, Lexington VA Medical Center (Ky) (J.W.A.); and Sections of General Internal Medicine (G.R.) and Cardiology (M.E.) and Department of Medicine, Memphis VA Medical Center and University of Tennessee.

Background and Purpose A low HDL cholesterol (HDL-C) frequently occurs in conjunction with a desirable LDL cholesterol (LDL-C) and is a risk factor for coronary heart disease (CHD). Additionally, the presence of carotid atherosclerosis is a strong and independent predictor of morbidity and mortality in patients with CHD. This article describes the prevalence and correlates of sonographically detected carotid atherosclerosis in men with low levels of HDL-C and CHD but without elevated levels of LDL-C or total cholesterol.

Methods High-resolution B-mode ultrasonography was used to quantify intima-media wall thickness (IMT) in the common and internal carotid arteries and at the carotid artery bifurcation in 202 randomly selected male veterans with CHD and low levels of HDL-C who are participating in the VA HDL Intervention Trial. Ultrasonographic measurement of carotid artery wall stiffness was determined in a subset of 94 of these individuals.

Results The mean maximum and single greatest carotid artery IMT measurements were 1.41 and 2.58 mm, respectively. The prevalence of ultrasound-detected carotid atherosclerosis as defined by a mean maximum IMT 1.3 mm was 58.9% and by single maximum IMT 1.5 mm was 87.1%. IMT was associated with increased age, lower extremity arterial disease, systolic blood pressure, and ultrasonographically measured carotid artery stiffness.

Conclusions Men with low levels of HDL-C and CHD but without elevated LDL-C or total cholesterol have a very high prevalence of ultrasound-detected carotid artery atherosclerosis.

Key Words: carotid artery diseases • cholesterol • epidemiology • ultrasonics

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