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The letter questions clinical interpretation of the proposed sequence of controlling blood pressure before lipids and glucose, urges cautious statistical interpretation, and requests clarification.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/the-impact-of-hyperlipidemia-and-carotid-atherosclerosis-letter-to-the-editor/436602/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/the-impact-of-hyperlipidemia-and-carotid-atherosclerosis-letter-to-the-editor/436602.png","ImageObject",300,407,{"name":42,"@type":43},"Alex 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\nSzu-Ting Yanga,b,c, Chia-Hao Liua,b,c, Peng-Hui Wanga,b,c,d,*  \naDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cFemale Cancer Foundation, Taipei, Taiwan, ROC; dDepartment of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC  \nDEAR EDITOR,  \nWe have read the article entitled “Combined effects of hypertension, hyperlipidemia, and diabetes mellitus on the presence and severity of carotid atherosclerosis in community-dwelling elders: A community-based study” published in the February issue of the Journal of the Chinese Medical Association with interest.1 Lu et al1 investigate the effect of comorbidities, such as hypertension, diabetes mellitus (DM), and hyperlipidemiaon carotid atherosclerosis in community-dwelling elders. The authors found that the number of comorbidities was the most predictive factor of incidence and severity of atherosclerosis. We congratulated the authors’ successful publication, but there are some questions that raised our curiosity, and clarification is greatly appreciated.  \nFirst, the authors did not provide the indications for these participants’ extracranial carotid artery ultrasound scans. The wide screening of the carotid atherosclerosis in the general population is still highly debated.2 Without a clear demonstration of the background of the current study, the findings may be at risk of bias.  \nSecond, it is necessary to give a clear description of the time interval between measurements of background data, such as blood pressure (BP) measurement, glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) levels and performing a carotid artery ultrasound scan. The background data maybe varied greatly and at a high risk of misinterpretation.  \nThird, it is believable that some patients might be treated with antihypertensive agents, antidiabetic, and antihyperlipidemic medications, and these critical confounding factors should not be neglected. Without the aforementioned information, it is hard to define the relationship between hypertension, DM, hyperlipidemia, and atherosclerosis. Furthermore, we believe that this is the explanation that hyperlipidemia alone or DM alone did not demonstrate an increased odds ratio for atherosclerosis in  \n* Address correspondence. Dr. Peng-Hui Wang, Department of Obstetricsand Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail addresses: phwang@vghtpe.gov.tw](ROC. E-mail addresses: phwang@vghtpe.gov.tw); [pongpongwang@gmail.com](pongpongwang@gmail.com) (P.-H. Wang).  \nConflicts of interest: Dr. Peng-Hui Wang, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other 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: 451-452.  \nReceived January 13, 2023; accepted January 14, 2023.  \ndoi: 10. 1097/JCMA.0000000000000909.  \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/))  \nthisstudy. Based on their results, we are wondering to know whether the consequence hypothesis as “subjects affected by hyperlipidemia alone might not benefit from lipid-lowering treatment” could be made. The 2019 American College of Cardiology/American Heart Association guideline pointed out that statin therapy is the first-line treatment for primary prevention of ather","cbCaiijxg1xmYHL8","https://ap.wps.com/l/cbCaiijxg1xmYHL8","pdf",287033,"English","# Letter to the Editor\n## Study background and potential bias\n## Timing of measurements\n## Confounding medications\n## Treatment implications and clinical recommendations\n## Overall comments and acknowledgments\n## References","[{\"question\":\"What core findings of the original study does the letter discuss?\",\"answer\":\"The letter highlights that the number of comorbidities was reported as the most predictive factor for the incidence and severity of carotid atherosclerosis among community-dwelling elders.\"},{\"question\":\"Which methodological gaps are raised regarding the carotid ultrasound scans?\",\"answer\":\"The author notes that indications for extracranial carotid artery ultrasound were not provided, making screening practices and potential bias difficult to evaluate.\"},{\"question\":\"What confounders does the letter emphasize that may affect the relationship between comorbidities and atherosclerosis?\",\"answer\":\"The letter stresses that antihypertensive, antidiabetic, and antihyperlipidemic medications could act as critical confounding factors and should not be neglected.\"}]","The impact of hyperlipidemia and carotid atherosclerosis - Letter to the Editor | PDF",1790678494]