Risk Factors for Plaque Vulnerability in a Community Population: Endothelial Function and Arterial Stiffness Indexes

Rupture of atherosclerotic plaques and subsequent acute cardiovascular complications remain a major cause of morbidity and mortality throughout the world. Despite recent advances in treatment, we have not yet identified the means to prevent atherosclerotic vascular disease has not been met. It remains a challenge to determine at an early stage whether an atherosclerotic plaque will become unstable and vulnerable. Therefore, this study aim to identify key risk factors associated with the stability and vulnerability of carotid artery plaques, which may offer valuable insights for the early prevention of cardiovascular and cerebrovascular diseases.

We enrolled a total of 136 patients with stable atherosclerotic plaques and 635 with vulnerable plaques. Arterial stiffness and endothelial dysfunction were assessed using a cardiovascular function monitor and the Endo-PAT2000 device (Itamar Medical Ltd.), respectively. Differences between groups were compared using the Student's t-test for normally distributed data and the chi-squared test for non-normally distributed data. We developed a logistic regression to analyzed the association of these factors with carotid plaque stability.

Carotid-femoral pulse wave velocity (cf-PWV) and the reactive hyperemia index (RHI) were not different between the stable and unstable plaque groups (cf-PWV: 9.48 ± 2.07, 9.59 ± 1.79, P > 0.05; RHI: 1.58 ± 0.57, 1.62 ± 0.39, P > 0.05). The male sex, a smoke history, ejection, and duration were risk factors for plaque stability. Correlation analysis showed that lipids were not correlated with plaque stability and aortic hemodynamic parameters were correlated with plaque vulnerability. Multivariate logistic regression analysis demonstrated that the sex (OR: 0.1759, P < 0.001, 95% CI: 0.1077-0.2874), aortic augmentation index (OR: 1.0366, P < 0.001, 95% CI: 1.0175-1.0560), subendocardial viability ratio (OR: 0.9626, P < 0.001, 95% CI: 0.9535-0.9717), and distance (OR: 0.9854, P < 0.001, 95% CI: 0.9804-0.9903) presented significant correlation with plaque vulnerability.

There was insufficient evidence to indicate that RHI, cf-PWV were related to plaque stability. However, male, decreased of subendocardial viability ratio, increased of aortic augmentation index, and the shorter the distance between carotid-femoral arteries had the greater the possibility of vulnerable plaque, which provides a reference for the early prevention of cardiovascular and cerebrovascular diseases.