Comparative analysis of lipid and blood glucose profiles and their association with short-term progression of carotid plaque among middle-aged adults

Both traditional lipid ratios, particularly the total cholesterol/HDL-C ratio, and indices of insulin resistance, such as triglyceride-glucose index, are significant risk factors of carotid plaque progression. A dose-response relationship was observed between the accumulation of identified risk factors and the progression of carotid atherosclerotic plaques. Therefore, risk stratification in health screenings should prioritize these biomarkers to improve early detection and prevention strategies for atherosclerosis. Key messages What is already known on this topic: Existing evidence has established associations between various individual lipid parameters [e.g. low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG)] and glucose metabolism markers with the presence of carotid atherosclerosis. Furthermore, composite ratios like TC/high-density lipoprotein cholesterol (HDL-C) and the triglyceride-glucose index (TyG) index have shown superior predictive capability for cardiovascular risk compared to individual parameters in cross-sectional studies. However, comparative longitudinal analyses of these biomarkers for predicting short-term carotid plaque progression specifically in middle-aged, screening populations are scarce. What this study adds: This prospective cohort study demonstrates that among 11 lipid and glucose profiles, traditional lipid ratios-especially the TC/HDL-C ratio-and the insulin resistance index (TyG) are the strongest independent risk factors for short-term carotid plaque progression in a middle-aged health-screening cohort. We further established a clear dose-response relationship, where the accumulation of identified risk factors (specifically elevated LDL-C, TC/HDL-C, LDL-C/HDL-C, TC, and TG) significantly increased the risk of plaque development. How this study might affect research, practice or policy: Our findings suggest that the TC/HDL-C ratio, a cost-effective and readily available metric, should be prioritized in routine health screenings for better early risk stratification of subclinical atherosclerosis. For clinical practice, this supports integrated risk assessment that considers the cumulative effect of multiple lipid abnormalities. Future research should validate the established cut-off values prospectively and explore whether interventions targeting these key biomarkers can effectively retard plaque progression.