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Vulnerable Carotid Plaque is Associated with an Increased Risk of Intracerebral Hemorrhage in Individuals at High
Jie Li1, Ping Zhang1, Hong Chen1
1Department of Neurology, Deyang People's Hospital, Deyang, PR China.
Insights
Vulnerable carotid artery plaques increase intracerebral hemorrhage risk in high-risk stroke individuals. This association is particularly strong in women, independent of traditional vascular risk factors.
Area of Science:
- Neurology
- Vascular Medicine
- Epidemiology
Background:
- Carotid artery plaques are a known risk factor for stroke.
- Identifying specific plaque characteristics associated with different stroke types is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between carotid artery plaques and the risk of incident intracerebral hemorrhage (ICH).
- To determine if vulnerable carotid plaques independently predict ICH in high-risk stroke individuals.
Main Methods:
- A population-based cohort study in southwestern China included 2644 high-risk stroke participants.
- Participants were followed for five years to ascertain new-onset ICH events.
- Multivariate logistic regression and stratified analyses were used to assess the association between carotid plaque characteristics and ICH risk.
Main Results:
- Vulnerable carotid plaques were identified in 16.1% of participants.
- A total of 22 ICH events occurred during follow-up.
- Vulnerable carotid plaque was significantly associated with increased ICH risk (aRR 3.72, p=0.013), especially in women (aRR 26.3, p<0.001).
Conclusions:
- Vulnerable carotid artery plaques are an independent predictor of intracerebral hemorrhage in Chinese individuals at high risk for stroke.
- The association between vulnerable plaques and ICH is notably pronounced in the female population.
- These findings suggest vulnerable carotid plaques may play a critical role in hemorrhagic stroke pathogenesis, particularly in women.
Objectives:
To assess the association between carotid artery plaques and the risk of incident intracerebral hemorrhage (ICH) event in high-risk individuals for stroke.
Methods:
We conducted a population-based cohort study using the longitudinal participant-level data of a multicenter, cross-sectional survey in southwestern China. 2644 high-risk participants for stroke were enrolled in the year 2015. The primary outcome was new-onset ICH events during a five-year follow-up period. Multivariate logistic regression was performed to identify the association between carotid plaque and new-onset ICH. Stratified analyses and interaction tests were conducted to identify variables that might modify the association between vulnerable carotid plaque and ICH.
Results:
Among 2644 high-risk individuals enrolled, carotid plaques were found in 904 (34.2%) subjects, including 479 (18.1%) with stable plaques and 425 (16.1%) with vulnerable plaques. During a five-year follow-up period, 22 (0.83%) participants developed ICH. Vulnerable carotid plaque was associated with an increased risk of new-onset ICH in multivariable analyses (adjusted RR 3.72, 95 % CI 1.32 to 10.46, p=0.013). Stratified analyses and interaction analyses demonstrated the association between vulnerable carotid plaque and ICH was not changed by age, family history of stroke, hemorrhagic stroke and chronic disease, smoking, drinking, physical activity, BMI, antihypertensives, and antithrombotic drugs (all p for interaction>0.05). However, among the female cohort, participants with vulnerable plaques had a significantly higher risk of ICH compared with participants without vulnerable plaques (crude RR=9.8; 95%CI: 3.1-31.3, p<0.001; adjusted RR=26.3, 95%CI: 5.5-124.5, p<0.001), but not in man (p>0.05).
Conclusion:
In Chinese individuals at high risk of stroke, vulnerable carotid artery plaques are associated with an increased risk of intracerebral hemorrhage independent of classical vascular risk factors, especially in female individuals.
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