Subclinical Atherosclerosis Markers of Carotid Intima-Media Thickness, Carotid Plaques, Carotid Stenosis, and Mortality in Community-Dwelling Adults.

Chuan-Wei Yang,Mu-Cyun Wang,Yuh-Cherng Guo,Cheng-Chieh Lin,Chiu-Shong Liu,Chih-Hsueh Lin,Tsai-Chung Li,Shing-Yu Yang,Chung-Hsiang Liu,Chia-Ing Li

doi:10.3390/ijerph17134745

Abstract

Carotid intima–media thickness (IMT), plaque, and stenosis are widely used as early surrogate markers of subclinical atherosclerosis and strong predictors of future deaths and cardiovascular events. Albuminuria is an indicator of generalized endothelial dysfunction that speeds up atherosclerosis. However, previous studies reporting these associations cannot rule out the confounding effect of albuminuria. We aimed to examine the independent and joint relationships between IMT markers and 10-year mortality in community-dwelling Taiwanese adults. This work was a community-based prospective cohort study consisting of 2956 adults aged at least 30 years recruited in 2007 and followed up through 2019. Cox proportional hazard regression models were used to examine associations of these subclinical atherosclerosis markers with mortality. During an average of 9.41 years of follow up, 242 deaths occurred. The mortality rate was 8.70 per 1000 person-years. Compared with those with carotid IMT less than 1.0 mm, persons with severely increased carotid IMT (≥2.0 mm) had an increased risk for death (hazard ratio (HR): 1.79; 95% confidence interval (CI): 1.07, 3.00). Compared with those without carotid plaque, persons with carotid plaque were more likely to have an increased risk for death (1.65; 1.21–2.32). Compared with those with carotid stenosis less than 25%, persons with carotid stenosis of 25–36% had a significant increased risk for death (1.57; 1.12–2.22). Considering these three IMT markers along with the traditional risk factors (c-statistic: 0.85) significantly increased their predictive ability of mortality compared with any individual variable’s predictive ability (all p-values < 0.001 for comparisons of c-statistic values). Carotid IMT measures, including IMT thickness, carotid plaque, and carotid stenosis were significant independent predictors of mortality. Our study supports evidence of blood pressure-related media thickening markers to assess future mortality risks in Chinese adults of general population.

Highlights

Cardiovascular disease (CVD) is the number one cause of death globally, causing an estimated17.9 million deaths each year, one-third of which occur prematurely in persons aged 70 years and younger [1]
We explored the joint effect of three intima–media thickness (IMT) markers: carotid plaque, IMT, and carotid stenosis
IMT was moderately correlated with carotid plaque and carotid stenosis and carotid plaque with carotid stenosis

Summary

Introduction

Cardiovascular disease (CVD) is the number one cause of death globally, causing an estimated17.9 million deaths each year, one-third of which occur prematurely in persons aged 70 years and younger [1]. The American Heart Association suggests carotid artery ultrasound, a noninvasive imaging test, for the evaluation of cerebrovascular and cardiac disease risks. Carotid intima–media thickness (IMT), a noninvasive, B-mode ultrasound-based measure of the carotid artery by ultrasonography, is a well-established and commonly used early surrogate marker of subclinical atherosclerosis [3]. Carotid IMT predicts CVD incidence or death in the participants of the atherosclerosis risk in communities (ARIC) study recruited from four communities in the United States of America [4] and in asymptomatic persons with at least three CVD risk factors from five European countries [5]. Carotid IMT modestly improves the prediction of CVD death or all-cause mortality after considering the traditional risk factors in participants of the Cardiovascular Health Study (CHS) [6]

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