Atherogenic lipid indices are associated with carotid intima-media thickness and local carotid stiffness parameters in spondyloarthritis: a cross-sectional study

Abstract

Patients with spondyloarthritis (SpA) have an increased risk of cardiovascular disease that is not fully explained by traditional cardiovascular risk factors. Chronic inflammation may alter lipid metabolism and contribute to the lipid paradox, limiting the value of conventional lipid parameters for cardiovascular risk assessment. Composite atherogenic lipid indices have emerged as potential markers of residual cardiovascular risk, but their relationship with subclinical vascular damage in SpA remains incompletely understood. To investigate the association between atherogenic lipid indices and markers of subclinical atherosclerosis and arterial stiffness in patients with spondyloarthritis. This cross-sectional study included 150 patients with SpA, comprising 109 patients with ankylosing spondylitis and 41 patients with psoriatic arthritis. Lipid profile, atherogenic index of plasma (AIP), Castelli risk indices I and II, non-high-density lipoprotein cholesterol (non-HDL-C), and atherogenic coefficient were assessed. Carotid intima-media thickness (CIMT) and arterial stiffness parameters, including local carotid pulse wave velocity (PWV), β-stiffness, pressure-strain elastic modulus (EP), arterial compliance (AC), and augmentation index (AI), were evaluated using carotid ultrasonography with echo-tracking technology. Associations were analyzed using Spearman correlation and multivariable linear regression models. Triglycerides demonstrated the strongest and most consistent correlations with vascular parameters, including CIMT (ρ = 0.241, p  = 0.003), β-stiffness (ρ = 0.314, p  < 0.001), local carotid PWV (ρ = 0.325, p  < 0.001), and EP (ρ = 0.318, p  < 0.001). Non-HDL-C was significantly associated with CIMT (ρ = 0.248, p  = 0.002), β-stiffness (ρ = 0.195, p  = 0.017), local carotid PWV (ρ = 0.249, p  = 0.002), and EP (ρ = 0.225, p  = 0.006). AIP correlated positively with CIMT, β-stiffness, local carotid PWV, and EP and remained independently associated with local carotid PWV after multivariable adjustment (B = 0.534, 95% CI 0.005–1.063; β = 0.150, p  = 0.048), whereas non-HDL-C remained independently associated with CIMT (B = 0.027, 95% CI 0.002–0.053; β = 0.149, p  = 0.033). In contrast, LDL-C and HDL-C demonstrated limited associations with vascular parameters. Atherogenic lipid indices are associated with carotid structural and functional vascular parameters in patients with spondyloarthritis. Non-HDL-C and AIP were independently associated with CIMT and PWV, respectively, suggesting that these indices may provide complementary information regarding vascular characteristics in patients with SpA.