Skin cholesterol content identifies increased carotid intima–media thickness in asymptomatic adults

Background A noninvasive assay to measure skin Tc recently has become available for use in the outpatient setting as a cardiovascular (CV) risk prediction tool. The purpose of this study was to determine whether skin tissue cholesterol content (skin Tc) levels are associated with increased carotid intima–media thickness (CIMT) after adjusting for known CV risk factors and Framingham CV risk. Methods Consecutive patients without known vascular disease who were referred for determination of CIMT underwent B-mode ultrasonography of the carotid arteries and measurement of skin Tc using a noninvasive assay. Use of medications, cardiac risk factors, and Framingham 10-year CV risk were determined prospectively. Multivariable regression was used to determine predictors of increased CIMT. Results Among 81 subjects, the mean (SD) age was 55.6 (7.7) years and the mean skin Tc was 95.9 (18.3) U. Carotid intima–media thickness was significantly higher among individuals in the highest quartile of skin Tc (0.87 vs 0.76 mm, P = .011). In multivariable analyses, skin Tc was associated with increased CIMT even after adjusting for age, sex, glucose, systolic blood pressure, total/high-density lipoprotein cholesterol ratio, and use of lipid-lowering therapy (odds ratio [OR] per 10-unit increase = 1.590, 95% CI 1.525-1.658, P = .031). Skin Tc also was associated with increased CIMT after adjustment for Framingham risk (OR = 1.341, 95% CI 1.302-1.380, P = .048). Conclusions Skin Tc is an easy-to-measure, noninvasive marker that can help identify subclinical atherosclerosis in asymptomatic middle-aged adults, even after controlling for risk factors and CV risk predicted by the Framingham model.