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Association of Carotid Artery Plaque With Cardiovascular Events and Incident Coronary Artery Calcium in Individuals
Anurag Mehta1, Joseph Rigdon2, Matthew C Tattersall3
1Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA (A.M., L.S.S.).
Insights
Carotid artery plaque presence and extent predict coronary heart disease risk and new coronary artery calcium (CAC) in asymptomatic individuals with no initial CAC. This finding aids in refining cardiovascular disease risk assessment for low-risk populations.
Area of Science:
- Cardiovascular medicine
- Radiology
- Preventive cardiology
Background:
- Absence of coronary artery calcium (CAC) typically indicates low cardiovascular disease (CVD) risk in asymptomatic individuals.
- Carotid artery plaque is a known CVD risk marker, but its prognostic value in individuals with zero CAC is not well-defined.
Purpose of the Study:
- To investigate the association between carotid artery plaque and long-term cardiovascular risk, including incident coronary heart disease (CHD), stroke, and new CAC development.
- To evaluate the role of carotid plaque presence and extent in refining risk stratification among individuals initially classified as low risk due to zero CAC.
Main Methods:
- Utilized data from the Multi-Ethnic Study of Atherosclerosis, focusing on participants with a baseline CAC score of 0.
- Carotid plaque was assessed using B-mode ultrasonography; participants were followed for incident CVD events and serial CAC progression via computed tomography scans.
- Cox proportional hazards regression models were employed to analyze the association of carotid plaque with outcomes, adjusting for relevant covariates.
Main Results:
- Among 2673 participants with baseline zero CAC, 36% had detectable carotid plaque.
- Carotid plaque presence and plaque score were independently associated with increased risk of incident coronary heart disease (CHD) and development of incident coronary artery calcium (CAC).
- No significant association was found between carotid plaque and incident stroke or overall cardiovascular disease events.
Conclusions:
- Carotid artery plaque presence and its extent are significant independent predictors of long-term coronary heart disease risk and incident coronary artery calcium in asymptomatic individuals with an initial CAC score of 0.
- These findings suggest that carotid plaque assessment can enhance cardiovascular risk stratification beyond CAC alone in select asymptomatic populations.
- The study highlights the utility of non-invasive imaging markers for identifying individuals who may benefit from closer monitoring or preventive interventions despite a low initial CAC score.
Background:
Absence of coronary artery calcium (CAC) identifies asymptomatic individuals at low cardiovascular disease risk. Carotid artery plaque is a marker of increased risk, but its association with cardiovascular risk and incident CAC in people without CAC is unclear.
Methods:
Multi-Ethnic Study of Atherosclerosis participants with CAC score of 0 at enrollment who also underwent carotid plaque measurement using B-mode ultrasonography were prospectively followed for incident coronary heart disease, stroke, and cardiovascular disease events, and CAC (score >0 on up to 3 serial computed tomography scans). The association of carotid plaque presence and plaque score (Ln[score+1]) at baseline with cardiovascular events and incident CAC was evaluated with Cox proportional hazards regression models adjusted for demographics, risk factors, and statin use.
Results:
Among these 2673 participants (58 years, 64% women, 34% White, 30% Black, 24% Hispanic, and 12% Chinese), carotid plaque at baseline was observed in 973 (36%) and the median plaque score (range, 1-12) among those with plaque was 1. A total of 79 coronary heart disease, 80 stroke, and 151 cardiovascular disease events were observed during 16.1 years of follow-up. Carotid plaque presence and plaque score were independently associated with coronary heart disease risk (HRs, 1.66 [95% CI, 1.04-2.66]; and 1.48 [95% CI, 1.01-2.17], respectively) but not with stroke and cardiovascular disease risk. A total of 973 (36.4%) participants developed CAC over the evaluation period (median 9.3 years). Carotid plaque presence and plaque score were independently associated with incident CAC (HRs, 1.34 [95% CI, 1.18-1.54]; and 1.37 [95% CI, 1.21-1.54]), respectively.
Conclusions:
The presence and extent of carotid plaque are associated with long-term coronary heart disease risk and incident CAC among middle-aged asymptomatic individuals with an initial CAC score of 0.
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