Association Between the Atherosclerotic Disease Risk Score and Carotid Artery Stenosis
Mark D Balceniuk1, Claire M Motyl1, Brian C Ayers1
1Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Insights
The Atherosclerotic Cardiovascular Disease (ASCVD) risk score shows a link to moderate/severe carotid artery stenosis (CAS). However, the ASCVD score is not sensitive or specific enough for screening asymptomatic patients for CAS.
Area of Science:
- Vascular Surgery
- Cardiology
- Neurology
Background:
- Carotid artery stenosis (CAS) is a leading treatable cause of ischemic stroke.
- Current guidelines do not recommend screening asymptomatic individuals for CAS.
- The ASCVD risk score estimates 10-year cardiovascular disease risk.
Purpose of the Study:
- To investigate the association between the ASCVD risk score and moderate/severe CAS.
- To evaluate the utility of the ASCVD risk score in identifying patients with significant carotid stenosis.
Main Methods:
- Retrospective review of 2,856 patients undergoing carotid ultrasound surveillance (2015-2018).
- Patients categorized into none-to-mild (<50%) and moderate-to-severe (≥50%) CAS groups using Strandness criteria.
- Statistical analyses included t-tests, multivariate analysis, and ROC curve analysis.
Main Results:
- ASCVD risk score significantly predicted moderate/severe CAS in multivariate analysis (OR 1.11 per 10% increase, P=0.004).
- ROC analysis showed an area under the curve of 0.59 for ASCVD score predicting moderate/severe CAS, with an optimal cutoff of 28.4%.
- A novel atherosclerotic disease model showed an AUC of 0.57 for predicting moderate/severe CAS.
Conclusions:
- This study is the first to link ASCVD risk score to moderate/severe CAS.
- The ASCVD risk score is associated with moderate/severe CAS but lacks the sensitivity and specificity for effective screening.
- Further research may be needed to refine risk prediction models for CAS.
Background:
Carotid artery stenosis (CAS) is the most frequently detected treatable cause of ischemic stroke. However, there are no recommendations to screen asymptomatic patients. The atherosclerotic cardiovascular disease (ASCVD) risk score estimates individuals' 10-year risk for developing cardiovascular disease. The objective of this study is to identify a relationship between the ASCVD risk score and moderate/severe CAS based on ultrasound findings.
Materials And Methods:
We performed a single-institution retrospective review of patients who underwent a surveillance ultrasound for CAS between 2015 and 2018. We used Strandness velocity criteria to separate patients into two cohorts: none to mild CAS (<50%) and moderate/severe CAS (≥50%). We performed Student's t-test, multivariate analysis, and receiver operator characteristic (ROC) curve analysis to determine a relationship between the ASCVD risk score and degree of CAS. We evaluated a new risk score model based on stepwise logistic regression of significant variables on univariate analysis.
Results:
Two thousand eight hundred and fifty-six patients with carotid ultrasounds (1623 with none to mild, 1161 with moderate, and 72 with severe disease) were included in the study. The ASCVD risk score significantly predicted moderate/severe CAS in an adjusted multivariate analysis. Each 10% increase in the ASCVD risk score corresponded to an additional 11% likelihood of moderate/severe stenosis (OR: 1.11 [1.04-1.20], P = 0.004). The ROC area under the curve for predicting moderate/severe CAS based on the ASCVD risk score was 0.59 (Youden index (J) = 0.14); the optimized ASCVD cutoff point was 28.4%. Our new atherosclerotic disease model demonstrated increased odds of moderate/severe CAS with scores greater than zero (ROC area under the curve = 0.57).
Conclusions:
This is the first study to demonstrate an association between atherosclerotic disease risk factors as measured by the ASCVD risk score and moderate/severe CAS. However, this tool is not sensitive or specific for using the ASCVD risk score as a screening mechanism for moderate/severe CAS.
More Related Videos
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Coronary Artery Disease I: Introduction
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:30Atherosclerosis I: Introduction
01:26Atherosclerosis III: Management
01:23Atherosclerosis IV: Nursing Management