Carotid plaque, intima-media thickness, and incident aortic stenosis: a prospective cohort study
Andreas Martinsson1, Gerd Östling2, Margaretha Persson2
1From the Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden (A.M., J.G.S); Cardiovascular Epidemiology, Department of Clinical Sciences (G.Ö., M.P., G.E., B.H., J.G.S.), Department of Clinical Sciences, Center for Primary Health Care Research (K.S.), and Department of Internal Medicine, Skåne University Hospital (O.M., J.G.S.), Lund University, Malmö, Sweden; and Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (C.A.). andreas.martinsson@med.lu.se.
Objective:
Aortic stenosis (AS) shares risk factors with atherosclerotic vascular disease. Carotid intima-media thickness (IMT) and plaque may reflect the cumulative damage from exposure to different atherosclerotic risk factors. We examined the relationship of carotid IMT and plaque with incident AS in a prospective population-based study.
Approach And Results:
A random sample of participants (age, 45-68 years) in the population-based Malmö Diet and Cancer Study underwent B-mode ultrasound with measurements of IMT and the presence of plaque in the common carotid artery (n=5079). Potential risk factors for incident AS were studied in age- and sex-adjusted and expanded multivariable-adjusted Cox regression models. A total of 69 (1.4%) participants developed AS during up to 20 years of follow-up. Significant risk factors for AS in age- and sex-adjusted analyses were (P<0.05) body mass index, low-density lipoprotein cholesterol, hypertension, diabetes mellitus, smoking, C-reactive protein, plaque, and IMT. In contrast, high-density lipoprotein cholesterol, triglycerides, height, and leukocyte count were not significantly associated with AS (P>0.05). After adjustments, IMT, plaque, age, smoking, C-reactive protein, low-density lipoprotein cholesterol, and diabetes mellitus remained significantly associated with incident AS. IMT was no longer significantly associated with AS after adjustments for plaque and systolic blood pressure, but plaque remained significantly associated with incident AS.
Conclusions:
Traditional cardiovascular risk factors were individually associated with incident AS, and in multivariable models low-density lipoprotein cholesterol, smoking, age, presence of plaque, C-reactive protein, and diabetes mellitus remained significant predictors of incident AS. AS represents a vascular disorder related to carotid plaque, with potential implications for the pathophysiology and prevention of this disease.
