Determinants of magnetic resonance imaging detected carotid plaque components: the Rotterdam Study
Quirijn J A van den Bouwhuijsen1, Meike W Vernooij, Albert Hofman
1Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Insights
Intraplaque hemorrhage and lipid core, indicators of unstable carotid plaque, are common in the general population, especially in men. Hypertension, smoking, and hypercholesterolemia are linked to these plaque components.
Area of Science:
- Cardiovascular Medicine
- Radiology
- Epidemiology
Background:
- Carotid atherosclerotic plaque components like intraplaque hemorrhage and lipid core influence plaque progression and destabilization.
- Understanding the association between these plaque components and cardiovascular disease risk factors is crucial but not well-studied.
Purpose of the Study:
- To investigate the prevalence of intraplaque hemorrhage and lipid core in carotid atherosclerotic plaques.
- To examine the association between these plaque components and cardiovascular risk factors in a general population.
Main Methods:
- Utilized high-resolution magnetic resonance imaging for carotid plaque characterization in 1006 participants from the population-based Rotterdam Study.
- Assessed plaque components including intraplaque hemorrhage, lipid core, and calcification, and analyzed their associations with cardiovascular risk factors.
Main Results:
- Intraplaque hemorrhage and lipid core were present in approximately 25% of plaques, occurring together in 9%.
- These components were more prevalent in men than women.
- Intraplaque hemorrhage was associated with older age, male sex, hypertension, and current smoking.
- Lipid core was more frequent in men and individuals with hypercholesterolemia.
Conclusions:
- Intraplaque hemorrhage and lipid core are frequent indicators of unstable carotid plaque in the general population with carotid wall thickening.
- Prevalence of these unstable plaque markers is higher in men.
- Hypertension and smoking are risk factors for intraplaque hemorrhage, while hypercholesterolemia is linked to lipid core presence.
Aims:
Components of carotid atherosclerotic plaque such as intraplaque haemorrhage and lipid core are important determinants of plaque progression and destabilization. The association between plaque components and risk factors for cardiovascular disease is not well studied.
Methods And Results:
Participants from the population-based Rotterdam Study with carotid wall thickening on ultrasound (n = 1006) underwent high-resolution magnetic resonance imaging for carotid plaque characterization. Maximum wall thickening, the degree of stenosis, and the presence of intraplaque haemorrhage, lipid core, and calcification were assessed in both carotid arteries and their associations with cardiovascular risk factors were investigated. Intraplaque haemorrhage and lipid core were present in almost 25% of plaques, respectively, and occurred simultaneously in 9% of plaques. In men, intraplaque haemorrhage and lipid core were more prevalent compared with women (28.8 vs. 18.3 and 28.9 vs. 21.7%, respectively). Intraplaque haemorrhage occurred more frequently at older age [odds ratio (OR) per 10 years 1.8, 95% confidence interval 1.6-2.1], in men (OR 2.2, 1.7-2.9), in persons with hypertension (multivariate adjusted OR 1.4, 1.1-1.8), and in current smokers (multivariate adjusted OR 1.6, 1.2-2.3). Men (OR 1.5, 1.2-1.9) and subjects with hypercholesterolaemia (multivariate adjusted OR 1.4, 1.1-1.7) more often exhibited a lipid core.
Conclusion:
In subjects from the general population with carotid wall thickening, intraplaque haemorrhage and lipid core-both considered indicators of unstable plaque-are highly frequent and more prevalent in men compared with women. Furthermore, different risk factors are associated with these plaque components: hypertension and current smoking were risk factors for the presence of intraplaque haemorrhage, and hypercholesterolaemia was the only risk factor for lipid core presence.
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