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The authors report that regression models’ strongest predictor is the number of common cardiovascular disease comorbidities, but inclusion of this composite limits conventional risk-factor variables. They compare odds ratios across HBL+HBP, DM+HBL, and DM+HBP combinations, finding broadly similar adjusted estimates and no significant group differences.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/reply-to-is-the-relation-between-three-comorbidities-and-carotid-atherosclerosis-dependent-on-the-sum-or-not/436808/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/reply-to-is-the-relation-between-three-comorbidities-and-carotid-atherosclerosis-dependent-on-the-sum-or-not/436808.png","ImageObject",300,407,{"name":92,"@type":93},"Melati","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What factor did the authors find as the strongest predictor for carotid atherosclerosis severity?","Question",{"text":112,"@type":113},"The number of common cardiovascular disease comorbidities, including hypertension, diabetes mellitus, and hyperlipidemia.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did the authors interpret the similarity of odds ratios across comorbidity combinations?",{"text":117,"@type":113},"They reported that adjusted odds ratios for advanced carotid atherosclerosis were similar for HBL+HBP, DM+HBL, and DM+HBP, with overlapping confidence intervals and no significant differences among groups.",{"name":119,"@type":110,"acceptedAnswer":120},"What did the authors conclude about the potential synergistic effect of diabetes versus hypertension?",{"text":121,"@type":113},"The combined-effect analyses suggested that the synergistic association for hypertension and diabetes with carotid atherosclerosis was similar, supported by comparable adjusted odds ratios and significantly overlapping confidence intervals.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},436808,1790812396,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","J Chin MedAssoc  \nLETTER TO THE EDITOR  \nReply to “Is the relation between three comorbidities and carotid atherosclerosis dependent on the sum or not?”  \nTzu-Wei Wua, Chao-Liang Choua,b, Shu-Xin Lub, Chun-Fang Chengc, Li-Yu Wanga,*  \naDepartment of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC; bDepartment of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC; cDepartment of Health, Tamsui Health Station, New Taipei City Government, New Taipei City, Taiwan, ROC  \nDEAR EDITOR,  \nWe would like to thank Li and Chang for their interest in our work.1 In their Letter to the Editor, they mentioned three concerns about our work.2 Listed below are our responses to their concerns.  \nFor the first concern, we found that the most predictive regression models for the presence and severity of carotid atherosclerosis included older age, male sex, cigarette smoking, and the number of common cardiovascular disease (CVD) comorbidities, including hypertension (HBP), diabetes mellitus (DM), and hyperlipidemia (HBL) . It is reasonable to assume that this composite variable ‘the number of common CVDcomorbidities’ should be included in all top predictive regression models. However, this composite variable was the most significant predictor of carotid atherosclerosis and also significantly correlated with other conventional CVD risk factors. As a result, none of the other conventional CVD risk factors would be eligible for inclusion when the model contained this composite variable. After exclusion this composite variable from multivariable regression analyses, the most predictive regression model included older age, male sex, cigarette smoking, HBP, and DM.  \nFor the second concern, we displayed the odd ratios (ORs) of having advanced carotid atherosclerosis in combinatory analyses. It is evident that the ORs for HBL+HBP, DM+HBL, and DM+HBP were similar since their 95% confidence intervals (CI) were significantly overlapped. In our work, the sample size of HBL+HBP was nearly 3-fold of DM+HBL and DM+HBP combined. Additionally, the number of advanced carotid atherosclerosis in HBL+HBP was more than 2-fold of DM+HBL and DM+HBP combined. Consequently, the adjusted OR for subjects who had any two of the common CVD comorbidities must be closer to that of HBL+HBP. When treating this composite variable ‘the number of common CVDcomorbidities’ as a categorical variable, the results showed that the adjusted ORs of having carotid atherosclerosis were  \n*Address correspondence. Dr. Li-Yu Wang, Department of Medicine, MacKay Medical College, 46, Section 3, Jhong-Jheng Road, San-Jhih District, New Taipei City 252, Taiwan, [ROC. E-mail address: yannbo@mmc.edu.tw](ROC. E-mail address: yannbo@mmc.edu.tw) (L.-Y. Wang). Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.  \nJournal of Chinese Medical Association. (2023) 86: 615-616.  \nReceived February 1, 2023; accepted February 2, 2023.  \ndoi: 10. 1097/JCMA.0000000000000897.  \nCopyright © 2023, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \nmonotonically increased with the number of common CVDcomorbidities (Table 1) .  \nFor the third concern, the prevalence rate of HBP was higher than those of HBL and DM. Also, the adjusted OR of having advanced carotid atherosclerosis was significantly elevated for HBP alone but was nonsignificantly different from the null value for HBL alone or DM alone. Moreover, the adjusted OR of having carotid plaque was of borderline significance for HBP alone but was close to the null value for HBL alone or DM alone. These pieces of evidence support the importance of HBPin atherosclerosis.  \nAs mentioned in our responses to their second concern, the adjusted ORs of hav","cbCaivlPyioYcf1C","https://ap.wps.com/l/cbCaivlPyioYcf1C","pdf",363619,"English","# Letter to the Editor\n## Response to the first concern\n## Response to the second concern\n## Response to the third concern\n## Additional combined-effect analyses","[{\"question\":\"What factor did the authors find as the strongest predictor for carotid atherosclerosis severity?\",\"answer\":\"The number of common cardiovascular disease comorbidities, including hypertension, diabetes mellitus, and hyperlipidemia.\"},{\"question\":\"How did the authors interpret the similarity of odds ratios across comorbidity combinations?\",\"answer\":\"They reported that adjusted odds ratios for advanced carotid atherosclerosis were similar for HBL+HBP, DM+HBL, and DM+HBP, with overlapping confidence intervals and no significant differences among groups.\"},{\"question\":\"What did the authors conclude about the potential synergistic effect of diabetes versus hypertension?\",\"answer\":\"The combined-effect analyses suggested that the synergistic association for hypertension and diabetes with carotid atherosclerosis was similar, supported by comparable adjusted odds ratios and significantly overlapping confidence intervals.\"}]","Reply to “Is the relation between three comorbidities and carotid atherosclerosis dependent on the sum or not?” | PDF",1790679125]