Evidence remains limited on whether the atherogenic index of plasma (AIP) is associated with rapid plaque progression (RPP) across diabetes status. An observational analysis published in the Journal of Cardiovascular Computed Tomography evaluated this relationship in 1485 adults. The mean age was 60.9 ± 9.2 years, 58.9% were men, and 23.8% had diabetes mellitus (DM). Serial coronary computed tomography angiography was used for assessment.

AIP was defined as the base-10 logarithm of the triglyceride to high-density lipoprotein cholesterol ratio. RPP was defined as an annual increase in percent atheroma volume (PAV) of at least 1.0%.

Over a median follow-up of 3.4 years, RPP occurred in 26.1% of participants. Individuals with DM had higher AIP levels and greater baseline plaque burden. They also showed a higher incidence of RPP than those without DM.

After multivariable adjustment, each 0.1-unit increase in AIP was associated with higher odds of RPP in individuals without DM. The odds ratio (OR) was 1.07, with a 95% confidence interval (CI) of 1.01-1.13 (p < 0.05). This association was not observed in individuals with DM. In this group, the OR was 1.04 (95% CI 0.95–1.14; p = 0.430).

These findings indicate that AIP is associated with RPP in adults without established DM. No significant association was observed in those with DM.