AIP-related indices (AIP-BMI, AIP-WC, and AIP-WHtR) were positively associated with subclinical carotid atherosclerosis, carotid intima-media thickness, plaque, and stenosis, with AIP-BMI showing the greatest diagnostic value for overall carotid atherosclerosis and CIMT.
Key Findings
Results
Per 1-SD increase in each AIP-related index was associated with increased odds of elevated carotid intima-media thickness (CIMT).
AIP-BMI was associated with CIMT: OR = 1.36 (95% CI = 1.31–1.41)
AIP-WC was associated with CIMT: OR = 1.34 (95% CI = 1.29–1.38)
AIP-WHtR was associated with CIMT: OR = 1.33 (95% CI = 1.28–1.38)
Study included 59,123 participants from the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP) in Hubei Province, China, 2017–2020
Cross-sectional study design
Results
Per 1-SD increase in each AIP-related index was associated with increased odds of carotid plaques.
AIP-BMI was associated with plaques: OR = 1.32 (95% CI = 1.28–1.37)
AIP-WC was associated with plaques: OR = 1.34 (95% CI = 1.29–1.38)
AIP-WHtR was associated with plaques: OR = 1.33 (95% CI = 1.29–1.38)
All three AIP-related indices showed positive associations with plaque presence
Results
AIP-BMI, AIP-WC, and AIP-WHtR were positively associated with carotid stenosis when analyzed by interquartile range quartiles.
Associations with stenosis were assessed by dividing each index into interquartile range (IQR) groups
Higher quartile groups (Q2, Q3, Q4) were compared with the Q1 reference group
All three AIP-related indices showed positive associations with stenosis across quartiles
Results
AIP-BMI had the greatest diagnostic value for overall carotid atherosclerosis (CA) and CIMT among the individual AIP-related indices.
AUC for CA: 0.833 (95% CI = 0.828–0.838)
AUC for CIMT: 0.817 (95% CI = 0.811–0.824)
ROC analyses were used to assess diagnostic performance
AIP-BMI outperformed AIP-WC and AIP-WHtR for these two outcomes
Results
AIP-BMI, AIP-WC, and AIP-WHtR all showed equivalent and greatest diagnostic value for carotid plaques among individual indices.
AUC for plaques: AIP-BMI = 0.842 (95% CI = 0.836–0.848), AIP-WC = 0.842 (95% CI = 0.836–0.847), AIP-WHtR = 0.842 (95% CI = 0.836–0.848)
All three indices had identical AUC values of 0.842 for plaque diagnosis
When all four indices (AIP, AIP-BMI, AIP-WC, and AIP-WHtR) were combined, the AUC for plaques was 0.871 (95% CI = 0.858–0.884)
The combined four-index model outperformed any single index for plaque diagnosis
Methods
Three novel composite indices combining AIP with measures of obesity (BMI, waist circumference, and waist-height ratio) were developed and evaluated in this study.
AIP-BMI combines atherogenic index of plasma with body mass index
AIP-WC combines atherogenic index of plasma with waist circumference
AIP-WHtR combines atherogenic index of plasma with waist-to-height ratio
These indices were developed to simultaneously capture lipid metabolism and adiposity-related cardiovascular risk
The study population of 59,123 participants was drawn from CSHPSIP in Hubei Province, China, from 2017 to 2020
What This Means
This research suggests that combining a standard blood lipid risk score (called the atherogenic index of plasma, or AIP) with common obesity measurements—body mass index (BMI), waist circumference, or waist-to-height ratio—creates composite indices that are strongly linked to early signs of artery disease in the neck (carotid atherosclerosis). The study analyzed over 59,000 adults in China and found that as these combined scores increased, so did the likelihood of having thickened carotid artery walls, artery plaques, and narrowing of the arteries. Among the individual composite scores, the AIP-BMI combination showed the best ability to detect overall carotid atherosclerosis and artery wall thickening, while all three composite scores performed equally well at identifying plaques.
The practical implication of these findings is that these composite indices—which are relatively simple to calculate from routine clinical measurements—may serve as useful screening tools for identifying people at risk of subclinical (early, symptom-free) carotid artery disease. Subclinical carotid atherosclerosis is an important risk factor for stroke, so early detection could help guide preventive interventions. When all four indices were combined together, their ability to detect plaques improved further (AUC of 0.871), suggesting that using multiple indices together may enhance diagnostic accuracy.
This research is based on a large cross-sectional study, meaning it captures a snapshot in time and cannot establish whether these index scores directly cause artery disease or simply occur alongside it. The authors note that future prospective studies—where participants are followed over time—are needed to confirm these associations and clarify how these indices might be used in clinical practice.
Li W, Zhang H, Yang S, Chen D, Tse L. (2026). Associations of atherogenic index of plasma related indices with subclinical carotid atherosclerosis.. Annals of medicine. https://doi.org/10.1080/07853890.2026.2687227