Atherosclerotic Carotid Plaque Composition and Incident Stroke and Coronary Events
Daniel Bos1, Banafsheh Arshi2, Quirijn J A van den Bouwhuijsen1
1Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
Insights
Intraplaque hemorrhage (IPH) in carotid artery plaques is a significant independent risk factor for stroke and coronary heart disease (CHD). This finding highlights IPH as a potential marker for vulnerable plaques in individuals with subclinical atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Radiology
Background:
- Atherosclerotic plaque composition, not just size, is increasingly linked to ischemic cardiovascular events.
- Large-scale population data on plaque composition in asymptomatic individuals are limited.
Purpose of the Study:
- To investigate the association between carotid plaque composition and the incidence of stroke and coronary heart disease (CHD) in a population-based cohort.
- To identify specific plaque characteristics, such as intraplaque hemorrhage (IPH), as potential predictors of cardiovascular events.
Main Methods:
- 1,349 asymptomatic individuals from the Rotterdam Study underwent high-resolution MRI of carotid arteries to assess plaque components (IPH, lipid-rich necrotic core, calcification) and size.
- Participants were followed for incident stroke and CHD using Cox regression models, adjusting for cardiovascular risk factors.
Main Results:
- During follow-up, 51 strokes and 83 CHD events occurred.
- The presence of intraplaque hemorrhage (IPH) was independently associated with increased risk of both stroke and CHD (HR 2.42 and 1.95, respectively).
- Lipid-rich necrotic core and calcification were not significantly associated with stroke or CHD incidence.
Conclusions:
- Intraplaque hemorrhage (IPH) in carotid atherosclerotic plaques is an independent risk factor for stroke and CHD.
- IPH shows promise as a marker of plaque vulnerability in individuals with subclinical atherosclerosis.
Background:
Increasing evidence suggests that atherosclerotic plaque composition rather than plaque size is linked to ischemic cardiovascular events, yet largescale population-based data in asymptomatic individuals remain scarce.
Objectives:
This study sought to investigate carotid plaque composition in relation to incident stroke and coronary heart disease (CHD) in a population-based setting.
Methods:
Between 2007 and 2012, 1,349 persons (mean age 72 years, 49.5% women) from the population-based Rotterdam Study who were free from a history of stroke or CHD, in whom carotid ultrasonography showed subclinical atherosclerosis, and who underwent high-resolution magnetic resonance imaging of the carotid arteries to assess plaque characteristics. These included the presence of specific plaque components (intraplaque hemorrhage [IPH], lipid-rich necrotic core, and calcification), and measures of plaque size (maximum plaque thickness and presence of stenosis of more than 30%). Individuals were continuously followed for the occurrence of stroke or CHD until January 1, 2015. The authors used Cox regression models to assess the association of the plaque characteristics with the incidence of stroke and CHD, with adjustments for age, sex, and cardiovascular risk factors.
Results:
During a median of 5.1 years' follow-up for stroke and 4.8 years for CHD, 51 individuals had a stroke and 83 developed CHD. Independent of maximum plaque thickness and cardiovascular risk factors, the presence of IPH was associated with incident stroke and CHD (fully adjusted hazard ratio: 2.42 [95% confidence interval: 1.30 to 4.50], and 1.95 [95% confidence interval: 1.20 to 3.14]). Presence of a lipid-rich necrotic core and calcification were not associated with stroke or CHD.
Conclusions:
The presence of IPH in the carotid atherosclerotic plaque is an independent risk factor for stroke and CHD. These findings indicate the promise of IPH as a marker of plaque vulnerability in healthy persons with subclinical atherosclerosis.
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