Risk of major adverse cardiovascular events in subjects with asymptomatic mild carotid artery stenosis

Hyunwook Kwon,Jee Won Park,Yong-Pil Cho,Minsu Noh,Sun U Kwon,Min-Ju Kim,Seung-Whan Lee,Hong-Kyu Kim,Tae-Won Kwon,Youngjin Han

doi:10.1038/s41598-018-23125-8

Hyunwook Kwon, Jee Won Park + Show 8 more

Open Access

https://doi.org/10.1038/s41598-018-23125-8

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Abstract

This study aimed to test the hypothesis that the risk of major adverse cardiovascular events (MACE) is similar for subjects with asymptomatic mild and moderate carotid artery stenosis (CAS). We enrolled a total of 453 subjects with asymptomatic CAS (30–69%) detected on baseline screening Doppler ultrasound (DUS) examination between January 2008 and December 2010. The follow-up DUS findings and MACE occurrence (fatal or nonfatal myocardial infarction or stroke and all-cause mortality) were compared between subjects with mild (30–49%) and moderate (50–69%) CAS during the 8-year follow-up period. There was no significant difference in the occurrence of MACE between subjects with mild (n = 289) and moderate (n = 164) CAS (13.8% vs. 15.9%, respectively; p = 0.56), although there was a nonsignificant trend toward an increased risk of major ipsilateral stroke in subjects with moderate CAS (1.4% vs. 4.3%; p = 0.06). Multivariate regression analysis indicated that worsening CAS was independently associated with MACE occurrence (hazard ratio [HR], 4.40; 95% confidence interval [CI], 2.65–7.27; p < 0.01), whereas an increased serum high-density lipoprotein cholesterol level was correlated with a decreased risk of MACE (HR, 0.42; 95% CI, 0.23–0.75; p < 0.01). The cumulative risk of MACE in subjects with asymptomatic mild CAS is similar to that in subjects with asymptomatic moderate CAS.

Highlights

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, and its prevention is less costly than the treatment of its complications
The 2013 American College of Cardiology/American Heart Association guidelines recommend that it is reasonable to repeat Doppler ultrasound (DUS) screening annually for persons with moderate carotid artery stenosis (CAS) but not for those with mild CAS2,6–8, and limited studies to date have examined the natural course of asymptomatic mild CAS
This finding highlights the fact that carotid atherosclerosis is a dynamic process associated with the risk of major adverse cardiovascular events (MACE) occurrence, which persists over time even in cases of asymptomatic mild CAS11

Summary

Introduction

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, and its prevention is less costly than the treatment of its complications. Carotid DUS screening could be a valuable tool to assist in CVD risk stratification for the application of preventive strategies in persons with few conventional risk factors. The 2013 American College of Cardiology/American Heart Association guidelines recommend that it is reasonable to repeat DUS screening annually for persons with moderate carotid artery stenosis (CAS) but not for those with mild CAS2,6–8, and limited studies to date have examined the natural course of asymptomatic mild CAS. Owing to recent advances in medical treatment, the annual risk of stroke has decreased to

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