Objective To analyze the risk factors of carotid atherosclerosis in physical examination population at different blood pressure levels.

Methods  A total of 6 912 subjects were retrospectively selected in people who underwent a physical examination and carotid artery color ultrasound examination at the medical examination center of The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from January 2020 to December 2023. The subjects were divided into carotid atherosclerosis group (n=2 629) and normal carotid artery group (n=4 283) according to the results of carotid artery ultrasound. Logistic regression was used to analyze the contributing risk factors of carotid atherosclerosis in people with different blood pressure.

Results The detection rate of carotid atherosclerosis in the subjects was 38.04% (2 629/6 912). The detection rates of carotid atherosclerosis in the normal blood pressure group, the high-normal blood pressure group, and the hypertension group were 25.16% (425/1 689), 35.45% (1 076/3 035), and 51.55% (1 128/2 188) respectively. Multivariate logistic regression analysis showed that male (OR=2.091, 95%CI 1.791–2.442), age (compared with ≤40 years, OR=3.945, 95%CI 3.166–4.916 for 40–50 years, OR=9.000, 95%CI 7.265–11.149 for ＞50–60 years, OR=17.973, 95%CI 13.964–23.134 for ＞60–70 years, OR=41.994, 95%CI 30.243–58.312 for ＞70 years), hypertension (OR=1.416, 95%CI 1.210–1.658), increased fasting blood glucose (compared with ＜6.1 mmol/L, OR=1.278, 95%CI 1.050–1.555 for 6.1–＜7.0 mmol/L, OR=1.523, 95%CI 1.279–1.814 for ≥7.0 mmol/L), increased low-density lipoprotein cholesterol (LDL-C) (OR=1.640, 95%CI 1.459–1.844), white blood cell count (OR=1.047, 95%CI 1.009–1.086), and platelet count (OR=1.001, 95%CI 1.000–1.002) were independent risk factors for carotid atherosclerosis (all P＜0.05). In people with normal blood pressure, male, age, fasting blood glucose ≥ 7.0 mmol/L, increased LDL-C, and monocyte count were independent risk factors for carotid atherosclerosis (all P＜0.05). In people with high-normal blood pressure, male, age, increased fasting blood glucose, and increased LDL-C were independent risk factors for carotid atherosclerosis (all P＜0.05). In hypertensive people, age, fasting blood glucose≥7.0 mmol/L, increased LDL-C, neutrophils, and creatinine were independent risk factors for carotid atherosclerosis (all P＜0.05).

Conclusions Age, increased fasting blood glucose and increased LDL-C are common risk factors for carotid atherosclerosis in people with different blood pressures. Besides these factors, male and monocyte count are independent risk factors for carotid atherosclerosis in people with normal blood pressure, male is independent risk factor for carotid atherosclerosis in people with high-normal blood pressure, and neutrophils and creatinine are independent risk factors for carotid atherosclerosis in people with hypertension.