[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-436508-105":59,"doc-detail-436508-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","reply-to-the-impact-of-hyperlipidemia-and-carotid-atherosclerosis","Reply to “The impact of hyperlipidemia and carotid atherosclerosis”","","Letter to the editor responding to concerns raised about a prior study on hyperlipidemia and carotid atherosclerosis. The authors clarify recruitment from two community-based cohorts, explain timing and ultrasound scan logistics during enrollment batches, and argue that concurrent antihypertensive, antidiabetic, and antihyperlipidemic medication use does not meet confounding criteria. They report that hyperlipidemia was not significantly associated in multivariable analyses, while hypertension showed elevated odds in combined analyses, suggesting blood pressure control may have greater impact.",{"@graph":69,"@context":123},[70,84,106],{"@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-the-impact-of-hyperlipidemia-and-carotid-atherosclerosis/436508/",{"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-the-impact-of-hyperlipidemia-and-carotid-atherosclerosis/436508.png","ImageObject",300,407,{"name":92,"@type":93},"WPS_1786070896","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How were participants recruited and where were ultrasound scans performed?","Question",{"text":113,"@type":114},"Participants were recruited from two community-based cohorts. During enrollment, extracranial carotid artery ultrasound scans, questionnaire interviews, physical examinations, and blood sampling were completed at the communities after informed consent.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Could timing differences between examinations and ultrasound scans bias the results?",{"text":118,"@type":114},"Ultrasound scans were not performed at the exact same date for all enrollees because of capacity limits. The average interval was 29.4 days, with about 90% of intervals under 60 days, and the authors state it was unlikely to introduce significant effects on presence and progression.",{"name":120,"@type":111,"acceptedAnswer":121},"Why did the authors consider medication use not to be a confounder?",{"text":122,"@type":114},"They note that definitions of hypertension, diabetes mellitus, and hyperlipidemia included current medication users. The authors argue these medication variables do not satisfy confounder criteria in case-control logic because they are unlikely to be given to healthy nonexposed subjects, and their analyses did not show results consistent with confounding.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},436508,1791330181,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":81,"preview_page_count":4},549768072016,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","J Chin MedAssoc  \nLETTER TO THE EDITOR  \nReply to “The impact of hyperlipidemia and carotid atherosclerosis”  \nLi-Yu Wanga,* , Tzu-Wei Wua, Chao-Liang Choua,b, Shu-Xin Lub, Chun-Fang Chengc  \naDepartment of Neurology, MacKay Memorial Hospital, New Taipei City, Taiwan, ROC; bDepartment of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC; cDepartment of Health, Bali Health Station, New Taipei City Government, New Taipei City, Taiwan, ROC  \nDEAR EDITOR,  \nWe would like to thank Yang et al. for their interest in our work.1 In their Letter to the Editor, they summarized our most important findings and also raised several concerns about our work.2 Listed below are our responses for their concerns.  \nFor the first concern, the study subjects of our work were recruited from two community-based cohorts.2 During the enrollment period, we provided extracranial carotid artery ultrasound scans to whom had voluntarily provided informed consent, completed questionnaire interviews, and received physical examinations and blood sampling. There was no indication for an ultrasound scan and all measurements, including questionnaire interviews, physical examinations, blood sampling, and ultrasound scans were performed at the communities.  \nFor the second concern, the enrollment of cohort members was conducted by batches. The duration of each batch was 4–5 months. All eligible volunteers completed questionnaire interviews, received physical examinations, and had their blood drawn for biochemical determinations at the date they provided informed consent. Due to the limitation of the capacity of ultrasound scans, not all enrollees received ultrasound scans at the same date of physical and biochemical examinations. The mean (standard deviation) interval between the dates of physical and biochemical examinations and ultrasound scans was 29.4 (24.5) days. Approximately 90% of the intervals were less than 60 days. Seven (0.9%) subjects had an interval of 91–113 days, and 403 (49.3%), 330 (40.4%), and 77 (9.4%) subjects had an interval of 0–30, 31–60, and 61–90 days, respectively. It is unlikely that the short intervals between the dates of physical and biochemical examinations and ultrasound scans would introduce significant effects on the likelihood of the presence and progression of carotid atherosclerosis.  \nFor the third concern, Yang et al. pointed out that the uses of antihypertensive, antidiabetic, and antihyperlipidemic medications are critical confounding factors.1 Indeed, in the study, the definitions of hypertension, diabetes mellitus (DM), and hyperlipidemia included subjects who currently use antihypertensive, antidiabetic, and antihyperlipidemic medications, respectively. However, the uses of these medications are not qualified as confounders. To be a confounder incase-control studies, the extraneous factor must be fulfilled two criteria: (1) the extraneous factor is associated with the study factor in  \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: 453.  \nReceived January 18, 2023; accepted January 19, 2023.  \ndoi: 10. 1097/JCMA.0000000000000896.  \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/))  \nthe control subjects, and (2) the extraneous factor is associated with the disease in the nonexposed subjects.3 It is unlikely that healthy subjects will receive antidiabetic or antihyperlipidemic medicatio","cbCaiggWOJnyUeDl","https://ap.wps.com/l/cbCaiggWOJnyUeDl","pdf",304577,"English","# Letter to the Editor\n## Responses to concerns","[{\"question\":\"How were participants recruited and where were ultrasound scans performed?\",\"answer\":\"Participants were recruited from two community-based cohorts. During enrollment, extracranial carotid artery ultrasound scans, questionnaire interviews, physical examinations, and blood sampling were completed at the communities after informed consent.\"},{\"question\":\"Could timing differences between examinations and ultrasound scans bias the results?\",\"answer\":\"Ultrasound scans were not performed at the exact same date for all enrollees because of capacity limits. The average interval was 29.4 days, with about 90% of intervals under 60 days, and the authors state it was unlikely to introduce significant effects on presence and progression.\"},{\"question\":\"Why did the authors consider medication use not to be a confounder?\",\"answer\":\"They note that definitions of hypertension, diabetes mellitus, and hyperlipidemia included current medication users. The authors argue these medication variables do not satisfy confounder criteria in case-control logic because they are unlikely to be given to healthy nonexposed subjects, and their analyses did not show results consistent with confounding.\"}]","Reply to “The impact of hyperlipidemia and carotid atherosclerosis” | PDF",1790678220]