High and Rising Atherogenic Index of Plasma Linked to Greater Carotid Atherosclerosis Risk: Study Shows
China: A prospective cohort study published in BMJ Open has revealed a strong link between long-term atherogenic index of plasma (AIP) levels and the development and progression of carotid atherosclerosis (CAS). The research, conducted by Hui Li and colleagues from the Department of Health Management Center, Hunan Provincial People’s Hospital, highlights the potential of AIP as an important biomarker for identifying individuals at higher risk of subclinical atherosclerosis.
The study followed 528 adults who underwent annual health examinations over three years from January 2019 to December 2021. Participants were divided into quartiles based on their AIP levels, and carotid atherosclerosis was evaluated using high-resolution ultrasonography. CAS progression was defined as the appearance of new carotid plaques or a significant increase in carotid intima-media thickness (CIMT) compared to baseline measurements.
The notable study findings were as follows:
- There was a clear and positive association between AIP levels and both the incidence and progression of carotid atherosclerosis.
- Individuals in the highest AIP quartile had a 2.45-fold greater risk of carotid intima-media thickness progression compared to those in the lowest quartile (HR: 2.45).
- Long-term trends in AIP were a significant factor influencing CAS progression.
- Participants with persistently high or rising AIP levels had a 3.3-fold increased risk of carotid plaque progression compared to those with consistently low AIP levels (HR: 3.33).
The analysis demonstrated that the relationship between AIP and CAS risk followed an approximately linear pattern, reinforcing the importance of monitoring AIP over time. According to the authors, these findings suggest that tracking changes in AIP trajectories during routine health check-ups could help identify individuals at heightened risk earlier, allowing for preventive strategies to be implemented before significant vascular damage occurs.
The researchers emphasized that AIP, a marker derived from triglyceride and HDL cholesterol levels, could serve as a cost-effective and easily accessible tool in cardiovascular risk assessment. “Regular monitoring of AIP trends may provide valuable insights for early detection of carotid atherosclerosis and guide targeted interventions,” they noted.
Despite its strengths, including the use of a three-year follow-up and trajectory-based analysis, the study had certain limitations. Being a single-center investigation, the findings may not fully represent broader or high-risk populations. The absence of data on lifestyle factors, inflammatory markers, and genetic variables also restricts the understanding of underlying mechanisms. Furthermore, as all participants were from China, applicability to other ethnic or demographic groups may be limited.
"Nevertheless, the study emphasizes the value of incorporating AIP into regular health assessments. By identifying individuals with persistently high or rising AIP levels, clinicians may be able to intervene earlier to prevent or slow the development of carotid atherosclerosis, ultimately reducing the risk of cardiovascular events such as stroke and heart attack," the authors concluded.
Reference:
Li H, Duan J, Chen J, Tan C, Hu C, Peng J. Association between long-term atherogenic index of plasma and carotid atherosclerosis: a prospective cohort study of a health examination population. BMJ Open. 2025 Jul 30;15(7):e098874. doi: 10.1136/bmjopen-2025-098874. PMID: 40738628.
