Beyond SCORE2: Subclinical Carotid Atherosclerosis and Associated Inflammatory, Metabolic and Renal Markers

Background: Conventional cardiovascular risk scores may not fully reflect the individual burden of subclinical atherosclerosis. We investigated the clinical and biochemical determinants of carotid plaque and assessed whether inflammatory, metabolic, and renal markers provide information beyond SCORE2. Methods: This observational study included 542 asymptomatic middle-aged adults without known atherosclerotic cardiovascular disease who underwent clinical evaluation, laboratory testing, SCORE2 estimation, and standardized carotid ultrasonography. Multivariable logistic regression was used to identify independent predictors of carotid plaque. The incremental contribution of renal function and SCORE2 was also evaluated. Results: In the primary model, older age, male sex, higher serum uric acid, and higher C-reactive protein (CRP) concentrations were independently associated with carotid plaque. Each 1 mg/dL increase in uric acid was associated with a 32.3% increase in plaque odds. After adding estimated glomerular filtration rate (eGFR), lower eGFR remained independently associated with plaque, whereas the uric acid association was attenuated. CRP and male sex remained significant. Serum uric acid correlated inversely with eGFR. In participants with complete biochemical data, uric acid, CRP, and eGFR remained independent predictors, whereas HbA1c and SCORE2 did not add significant predictive value. Conclusions: Carotid plaque was independently associated with inflammatory status, uric acid metabolism, renal function, and sex. Integrating CRP, uric acid, and eGFR with conventional risk assessment may improve detection of hidden subclinical vascular disease. A more integrated approach to cardiovascular risk assessment that incorporates inflammatory, metabolic and renal parameters could be used to improve identification of individuals with subclinical carotid vascular disease, rather than SCORE2 alone.