ABSTRACT NUMBER: ESOC2026A1293 LIPID BIOMARKERS AND CAROTID INTRAPLAQUE HEMORRHAGE: INTERIM ANALYSIS OF THE PROSPECTIVE MULTICENTER AGELESS STUDY

Abstract Background and aims Carotid intraplaque hemorrhage (IPH) is a marker of plaque vulnerability and associated with ischemic events. While LDL-cholesterol (LDL-C), lipoprotein(a) [Lp(a)] and apolipoprotein B (ApoB) are drivers of atherosclerosis, their associations with carotid IPH remain unclear. Methods Prospective, observational, multicenter study enrolling patients with asymptomatic or symptomatic carotid stenosis ≥30% (NASCET) undergoing standardized carotid plaque MRI. This interim analysis assessed associations between lipid parameters (Lp(a), LDL-C, ApoB,) and carotid IPH. Logistic regression models were applied for any IPH and symptomatic stenosis, using univariable and multivariable analyses adjusted for age, sex, smoking, diabetes, hypertension, and statin therapy. Given the sample size and IPH prevalence, the study was sufficiently powered to detect relatively large associations, whereas smaller effects may have remained undetected. Results Among 355 patients, 154 (43.4%) had carotid IPH. Lp(a) was not associated with IPH as a categorical or continuous variable in unadjusted or adjusted models. In contrast, LDL-C was independently associated with IPH (per +1 mmol/L aOR 1.45, 95%CI 1.11–1.88). ApoB showed no independent association with IPH after adjustment. For symptomatic carotid stenosis, strong associations were observed for LDL-C (per +1 mmol/L aOR 2.00, 95%CI 1.51–2.66) and ApoB (per +0.1 g/L aOR 1.13, 95%CI 1.02–1.26). Lp(a) was not associated with symptomatic status. Conclusions In this interim analysis, Lp(a) was not associated with IPH, whereas LDL-C and ApoB were strongly linked to symptomatic disease, suggesting differential roles of atherogenic lipoproteins in plaque vulnerability and clinical presentation. Conflict of interest All authors: nothing to disclose. Table 1 - belongs to Results Table 2 - belongs to Results