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Published on: September 27, 2024
Atherosclerotic Cardiovascular Disease Risk Scores are Associated with Carotid Intima-Media Thickness
Emily K Mewborn1,2, Elizabeth A Tolley3, David B Wright4
1School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
Insights
Atherosclerotic cardiovascular disease (ASCVD) risk scores are linked to carotid intima-media thickness (CIMT) but not CAD history. CIMT may offer a more direct method for ASCVD risk assessment.
Area of Science:
- Cardiology
- Vascular Biology
- Preventive Medicine
Background:
- Existing Atherosclerotic cardiovascular disease (ASCVD) risk calculators lack comprehensive accuracy for predicting 10-year risks of myocardial infarction, coronary artery disease death, or stroke.
- Carotid intima-media thickness (CIMT) serves as a surrogate marker with potential to enhance ASCVD risk estimation.
- The study investigated the association between ASCVD risk scores and subclinical coronary artery disease (CAD) history and CIMT in individuals with prediabetes.
Purpose of the Study:
- To derive ASCVD risk scores from historical data.
- To determine the association of these risk scores with subclinical CAD history.
- To ascertain the relationship between ASCVD risk scores and CIMT measurements.
Main Methods:
- Retrospective cross-sectional study utilizing an existing dataset of individuals with prediabetes.
- ASCVD risk scores were calculated using the online ASCVD Risk Estimator Plus calculator.
- Subclinical CAD history was defined by the presence of CAD, coronary plaque, or revascularization without a history of myocardial infarction (MI).
Main Results:
- No significant differences in ASCVD risk scores were found between participants with or without a history of CAD.
- Higher ASCVD risk scores correlated with older age, elevated systolic blood pressure, and increased CIMT measurements (arterial age, mean IMT common, mean IMT maximum).
- ASCVD risk scores demonstrated a significant association with plaque burden and were moderately correlated with CIMT measurements.
Conclusions:
- ASCVD risk scores are associated with CIMT measurements, suggesting CIMT's utility in direct ASCVD risk estimation.
- Current risk calculators, while useful, have limitations; CIMT may provide a more direct and comprehensive assessment of ASCVD.
- CIMT can aid in diagnosing ASCVD, evaluating plaque characteristics, and monitoring treatment effectiveness.
Abstract:
Atherosclerotic cardiovascular disease (ASCVD) risk calculators estimate the 10-year incident risk of myocardial infarction (MI), coronary artery disease (CAD) death, or stroke; however, they lack comprehensiveness and accuracy. Carotid intima-media thickness (CIMT) is a surrogate marker that may improve risk estimation acumen. The objective of this study was to derive ASCVD risk scores from historical data and determine whether these risk scores are associated with the history of subclinical CAD and CIMT. This retrospective cross-sectional study used an existing dataset of individuals with prediabetes. Subclinical CAD history was defined as the history of CAD, coronary plaque, or coronary revascularization without a history of MI. The online ASCVD Risk Estimator Plus calculator was used to derive individual risk scores. Chi-square or Fisher's exact tests for categorical variables and ANOVA for continuous variables detected differences among ASCVD risk categories. Linear regression of CIMT measurements on ASCVD risk scores ascertained ASCVD risk scores' utility in predicting CIMT measurements. The sample included 86 participants, 28% with a history of CAD, 60% male, and 95% White. No differences in risk scores existed between participants with or without CAD. Individuals with higher ASCVD risk scores were older (p ≤ .001) and had higher systolic blood pressure (p ≤ .001), CIMT arterial age (p = .003), mean IMT common (p ≤ .001), mean IMT maximum (p ≤ .001), and plaque burden (p = .02) measurements. ASCVD risk scores were significantly associated and moderately correlated with CIMT measurements. ASCVD risk scores were not associated with CAD history but were associated with CIMT measurements. While risk calculators provide a starting point for ASCVD risk estimation, physical tools like CIMT can diagnose ASCVD, categorize plaque quality, and track intervention efficacy. CIMT may be used for more direct ASCVD risk estimation. Risk scores are easily imputed from existing records but are only intended for incident risk, and their accuracy relies on the variables' availability and validity and the boundaries of the calculators.
