{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T07:14:37Z","timestamp":1771312477085,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Atherosclerotic cardiovascular and cerebrovascular diseases are still the main cause of global incidence rate and mortality. The LDL-C\/HDL-C ratio (LHR) has been identified as a potential biomarker for cardiovascular risk. However, the relationship between it and the long-term risk of carotid plaques is not yet clear, especially in low-income populations in China.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This prospective cohort study included adults aged \u226545\u202fyears without carotid plaque at baseline from low-income rural areas of Tianjin, China. Baseline characteristics were collected in 2014, and follow-up data were obtained in 2019. The primary outcome was the development of new carotid plaques, assessed using carotid ultrasound. The relationship between the LDL-C\/HDL-C ratio (LHR) and new carotid plaques was analyzed using multifactorial logistic regression, with the presence or absence of new-onset plaques as the dependent variable. Additionally, we utilized restricted cubic spline (RCS) regression to visually present the potential nonlinear relationship between LHR and the risk of carotid plaque.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Over the six-year follow-up period, 606 participants (38.3%) developed new carotid plaques. Higher LHR was significantly associated with an increased risk of new carotid plaques, with each unit increase in LHR corresponding to a 35.9% higher risk (OR\u202f=\u202f1.359, 95% CI: 1.180\u20131.566,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). The RCS curve indicated a non-linear positive association between LHR and the likelihood of carotid plaques (\n p<\/jats:italic>\n for non-linearity\u202f=\u202f0.019), with an optimal cut-off at 1.257. Logistic regression analysis confirmed that LHR\u202f&gt;\u202f1.257 was linked to increased odds of carotid plaques in both unadjusted (OR: 1.80,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001) and adjusted models (OR: 1.835,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), with LHR \u2264\u202f1.257 serving as the reference. In subgroup analysis, all subgroups consistently demonstrated a significant association between increased LHR (all OR &gt; 1).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The research results indicate that there is a non-linear positive correlation between LHR and the long-term risk of carotid plaques in middle-aged and elderly populations, suggesting that LHR may be an effective indicator for screening carotid plaques in grassroots middle-aged and elderly populations.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1771449","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:33:59Z","timestamp":1771310039000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between LDL-C\/HDL-C ratio and long-term carotid plaque risk in middle-aged and elderly rural populations: a prospective population study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yingzhe","family":"Shao","sequence":"first","affiliation":[{"name":"Department of Neurology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tianjin Medical University General Hospital","place":["Tianjin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hailu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Oncology, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yixin","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Basic Medical Sciences, Tianjin Medical University","place":["Tianjin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tianjin Medical University General Hospital","place":["Tianjin, China"]},{"name":"Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]},{"name":"Laboratory of Epidemiology, Tianjin Neurological Institute","place":["Tianjin, China"]},{"name":"Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin Neurological Institute","place":["Tianjin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianjia","family":"Ning","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tianjin Medical University General Hospital","place":["Tianjin, China"]},{"name":"Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]},{"name":"Laboratory of Epidemiology, Tianjin Neurological Institute","place":["Tianjin, China"]},{"name":"Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin Neurological Institute","place":["Tianjin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People\u2019s Hospital","place":["Tianjin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1056\/NEJMoa1406656","article-title":"Demographic and epidemiologic drivers of global cardiovascular mortality","volume":"372","author":"Roth","year":"2015","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2166","DOI":"10.1161\/CIRCULATIONAHA.117.029652","article-title":"Socioeconomic status and cardiovascular outcomes: challenges and interventions","volume":"137","author":"Schultz","year":"2018","journal-title":"Circulation"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e0300154","DOI":"10.1371\/journal.pone.0300154","article-title":"Association of poverty-income ratio with cardiovascular disease and mortality in cancer survivors in the United States","volume":"19","author":"Yogeswaran","year":"2024","journal-title":"PLoS One"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e2351225","DOI":"10.1001\/jamanetworkopen.2023.51225","article-title":"National and provincial-level prevalence and risk factors of carotid atherosclerosis in Chinese adults","volume":"7","author":"Fu","year":"2024","journal-title":"JAMA Netw Open"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2804","DOI":"10.3390\/jcm13102804","article-title":"Carotid plaques and hypertension as risk factors for cardiovascular disease and all-cause mortality in middle-aged adults","volume":"13","author":"D\u017eenkevi\u010di\u016bt\u0117","year":"2024","journal-title":"J Clin Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/1476-511X-9-69","article-title":"Association of the low-density lipoprotein cholesterol\/high-density lipoprotein cholesterol ratio and concentrations of plasma lipids with high-density lipoprotein subclass distribution in the Chinese population","volume":"9","author":"Tian","year":"2010","journal-title":"Lipids Health Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"549137","DOI":"10.1155\/2011\/549137","article-title":"LDL-C\/HDL-C ratio predicts carotid intima-media thickness progression better than HDL-C or LDL-C alone","volume":"2011","author":"Enomoto","year":"2011","journal-title":"J Lipids"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"600","DOI":"10.5551\/jat.37184","article-title":"Is high serum LDL\/HDL cholesterol ratio an emerging risk factor for sudden cardiac death? Findings from the KIHD study","volume":"24","author":"Kunutsor","year":"2017","journal-title":"J Atheroscler Thromb"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.cca.2020.10.014","article-title":"LDL-C\/HDL-C ratio associated with carotid intima-media thickness and carotid plaques in male but not female patients with type 2 diabetes","volume":"511","author":"Du","year":"2020","journal-title":"Clin Chim Acta"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e022757","DOI":"10.1136\/bmjopen-2018-022757","article-title":"LDL-C:HDL-C ratio and common carotid plaque in Xinjiang Uygur obese adults: a cross-sectional study","volume":"8","author":"Zhao","year":"2018","journal-title":"BMJ Open"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1186\/s12944-021-01575-w","article-title":"Low\u2212\/high-density lipoprotein cholesterol ratio and carotid plaques in patients with coronary heart disease: a Chinese cohort study","volume":"20","author":"Li","year":"2021","journal-title":"Lipids Health Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1186\/s12872-022-02942-w","article-title":"Serum LDL-C\/HDL-C ratio and the risk of carotid plaques: a longitudinal study","volume":"22","author":"Wu","year":"2022","journal-title":"BMC Cardiovasc Disord"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"23870","DOI":"10.1038\/srep23870","article-title":"Prevalence and risk factors of carotid plaque among middle-aged and elderly adults in rural Tianjin, China","volume":"6","author":"Zhan","year":"2016","journal-title":"Sci Rep"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"38618","DOI":"10.1038\/srep38618","article-title":"Sex differences in prevalence of and risk factors for carotid plaque among adults: a population-based cross-sectional study in rural China","volume":"6","author":"Zhao","year":"2016","journal-title":"Sci Rep"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1080\/00325481.2021.1997483","article-title":"Incidence and predictors of progression of carotid atherosclerosis in a low-income Chinese population-a prospective cohort study","volume":"134","author":"Lin","year":"2022","journal-title":"Postgrad Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1186\/s12933-023-01874-9","article-title":"Association of dynamic change of triglyceride-glucose index during hospital stay with all-cause mortality in critically ill patients: a retrospective cohort study from MIMIC IV2.0","volume":"22","author":"Cheng","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1159\/000343145","article-title":"Mannheim carotid intima-media thickness and plaque consensus (2004\u20132006\u20132011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European stroke conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011","volume":"34","author":"Touboul","year":"2012","journal-title":"Cerebrovasc Dis"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s12944-018-0758-9","article-title":"Relations of lipid parameters, other variables with carotid intima-media thickness and plaque in the general Chinese adults: an observational study","volume":"17","author":"Hou","year":"2018","journal-title":"Lipids Health Dis"},{"key":"ref20","first-page":"S58","article-title":"Plasma low-density lipoprotein cholesterol\/high-density lipoprotein cholesterol concentration ratio and early marker of carotid artery atherosclerosis","volume-title":"J Med Assoc Thai","author":"Nimkuntod","year":"2015"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2118","DOI":"10.1074\/jbc.M210828200","article-title":"Src kinase mediates phosphatidylinositol 3-kinase\/Akt-dependent rapid endothelial nitric-oxide synthase activation by estrogen","volume":"278","author":"Haynes","year":"2003","journal-title":"J Biol Chem"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1590\/s0100-879x2004000400014","article-title":"Endothelial mediators of 17 beta-estradiol-induced coronary vasodilation in the isolated rat heart","volume":"37","author":"Santos","year":"2004","journal-title":"Braz J Med Biol Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1067\/mlc.2002.123936","article-title":"Evidence of increased formation of products retaining strong antioxidant activity from estradiol-17beta oxidation in the presence of human plasma lipoproteins","volume":"139","author":"Subbiah","year":"2002","journal-title":"J Lab Clin Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/j.cardiores.2004.12.027","article-title":"Endothelial aging","volume":"66","author":"Brandes","year":"2005","journal-title":"Cardiovasc Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.maturitas.2010.04.006.","article-title":"Endothelial dysfunction and vascular disease in later life","volume":"67","author":"Virdis","year":"2010","journal-title":"Maturitas"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1196\/annals.1395.038","article-title":"Vascular smooth muscle and endothelial functions in aging","volume":"1100","author":"Yildiz","year":"2007","journal-title":"Ann N Y Acad Sci"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1771449\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:34:00Z","timestamp":1771310040000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1771449\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":26,"alternative-id":["10.3389\/fmed.2026.1771449"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1771449","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]},"article-number":"1771449"}}