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Implantation of a Carotid Cuff for Triggering Shear-stress Induced Atherosclerosis in Mice
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Combined Effects of Clonal Hematopoiesis and Carotid Stenosis on Cardiovascular Mortality

Roland Jäger1, Matthias Hoke2, Florian J Mayer1

  • 1Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.

Journal of the American College of Cardiology
|May 1, 2024
PubMed

Insights

Clonal hematopoiesis (CH), caused by somatic mutations, is a cardiovascular risk factor. CH presence significantly increases cardiovascular death risk in patients with carotid atherosclerosis, especially with severe stenosis.

Area of Science:

  • Cardiovascular Medicine
  • Genetics
  • Oncology

Background:

  • Clonal hematopoiesis (CH), characterized by the expansion of hematopoietic stem cells due to acquired somatic mutations, is an emerging cardiovascular risk factor.
  • The prognostic implications of CH in individuals with carotid atherosclerosis are not yet fully understood.

Purpose of the Study:

  • To investigate the prognostic significance of CH in patients diagnosed with carotid atherosclerosis using ultrasound.
  • To determine if CH can serve as an independent predictor of cardiovascular events in this patient cohort.

Main Methods:

  • Deep sequencing of key genes (DNMT3A, TET2, ASXL1, JAK2) was employed to detect CH in 968 patients with asymptomatic carotid atherosclerosis.
  • Patients underwent duplex sonography for carotid artery evaluation.
  • Multivariate analyses were conducted, incorporating age and traditional cardiovascular risk factors.

Main Results:

  • CH was identified in 13.7% of patients, with prevalence increasing with age.
  • The presence of CH was significantly associated with an elevated risk of cardiovascular death (HR: 1.50).
  • The combined assessment of CH and degree of carotid stenosis (>50%) showed a synergistic effect on cardiovascular mortality (adjusted HR: 1.60).

Conclusions:

  • CH status, alongside the severity of carotid atherosclerosis, serves as a joint predictor of long-term mortality.
  • Assessing CH provides valuable prognostic information for patients with asymptomatic carotid atherosclerosis, aiding in risk stratification.
Abstract

Keywords:
agingcarotid atherosclerosisclonalityinflammationprognosisrisk prediction

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