Carotid intima medial thickness in patients with severe hypertriglyceridemia

Background and aims Severe hypertriglyceridemia (HTG), defined as plasma triglyceride (TG) >10 mmol/L, is relatively uncommon, and its implications for atherosclerotic cardiovascular disease (ASCVD) risk remain somewhat unclear. We evaluated the association between severe HTG and carotid intima-media thickness (IMT), a marker for ASCVD. Methods We studied three clinical cohorts: 88 patients with severe HTG, 271 patients with familial hypercholesterolemia (FH) as a contrast group, and 70 normolipidemic controls. Carotid IMT was measured using standardized ultrasound imaging. Statistical analysis was conducted using one-way analysis of variance (ANOVA) to compare mean IMT values, analysis of covariance (ANCOVA) to adjust for confounding variables, specifically age and sex, as well as Spearman pairwise correlation analysis between variables. Results Unadjusted mean carotid IMT was greater in severe HTG and FH groups compared to controls, however, this was no longer significant after adjustment for age and sex. In contrast, adjusted carotid IMT was significantly different between the FH and control groups. Conclusions Our findings suggest that extreme TG elevations in severe HTG patients are not significantly associated with carotid IMT, in contrast to the increased IMT seen in FH. These findings add perspective to the complex relationship between severe HTG and ASCVD risk.