Arterial Stiffness Is Associated With Carotid Intraplaque Hemorrhage in the General Population

Abstract

Objective-The relation between arterial stiffness and atherosclerosis, and specifically the influence of arterial stiffness on plaque composition, is largely unknown. In a population-based study, we investigated the association between arterial stiffness and the presence and composition of carotid atherosclerotic plaques. Approach and Results-Arterial stiffness was measured in 6527 participants (67.0±8.6 years) using aortic pulse wave velocity (PWV). Presence of carotid atherosclerotic plaques was assessed with ultrasound. Subsequently, 1059 subjects with carotid plaques (>2.5 mm) underwent MRI to assess plaque composition (presence of intraplaque hemorrhage, lipid, and calcification). Generalized estimation equation analyses adjusted for age, sex, mean arterial pressure, heart rate, carotid wall thickening, pulse pressure, and traditional cardiovascular risk factors were used to study the association between PWV and the presence and composition of carotid atherosclerotic plaques. In multivariable analysis, higher PWV was independently related to higher prevalence of carotid atherosclerotic plaque on ultrasound (odds ratio for highest quartile of PWV compared with lowest quartile, 1.24 [95% confidence interval, 1.02-1.51]). Furthermore, higher PWV was associated with intraplaque hemorrhage (age-and sex-adjusted odds ratio per SD increase in PWV, 1. MRI has emerged as a noninvasive imaging modality that enables accurate identification of the main components of the atherosclerotic plaque. 17,18 The objective of this study was to investigate the association between arterial stiffness, as assessed by PWV, and the presence and various components of carotid atherosclerotic plaque in a large population-based cohort, using both ultrasound and MRI assessment of plaques. Materials and MethodsMaterials and Methods are available in the online-only Supplement. ResultsAmong the 6527 subjects (67.0±8.6 years) who underwent carotid ultrasonography, 2527 (39.6%) subjects had ≥1 carotid plaques of ≥2.5 mm. Table 1 shows population characteristics of participants with ultrasound carotid plaques compared with those without plaques. Comparison of both groups showed that subjects with atherosclerotic plaque had a higher prevalence of various cardiovascular risk factors, including lower high-density lipoprotein cholesterol, higher systolic blood pressure, lower diastolic blood pressure, higher prevalence of smoking, diabetes mellitus, hypertension, antihypertensive medication use, history of myocardial infarction, and stroke (P<0.001). Of all persons with carotid plaque on ultrasound, to date, for 1059 subjects carotid MRI scanning was available (Table 1). Although the MRI population was significantly younger, had lower body mass index, systolic and diastolic blood pressure, lower prevalence of diabetes mellitus, and hypertension compared with subjects with carotid plaque ≥2.5 mm on ultrasound, the differences of the absolute values were small. Table 2 shows the association between PWV and presence of plaque on ultrasound. In all mode...

Type 2 diabetes, glucose, insulin, BMI, and ischemic stroke subtypes

“…33 In addition, a causal association between T2D and arterial stiffness was found in a recent MR study. 34 Stiffening of the arteries may result in the development of atherosclerotic carotid plaques 35 and increased risk of large artery stroke. 36 The present study did not detect a statistically significant association between genetically predicted BMI and ischemic stroke or its subtypes.…”

RANK-L is a Potential Therapeutic Target in Homogeneous Atherosclerotic Plaques

“…This was confirmed by the evidence of a significant correlation between RANK-L, more expressed in homogeneous (calcified) plaques, and either β-index and PWV, suggesting that local arterial wall characteristics might affect plaque calcification. Nevertheless, in a recent large population-based cohort from the Rotterdam Study, a higher PWV was associated with presence and composition of carotid atherosclerotic plaques, in particular with intraplaque hemorrhage, whereas associations between arterial stiffness and lipid or calcification were less pronounced [18]. However, a direct comparison between our results and those from the Rotterdam Study is not possible for several reasons: larger number of recruited patients, use of magnetic resonance imaging (MRI) for the assessment of plaque composition and conventional measurement of PWV by two-points method.…”

Arterial Stiffness is an Independent Risk Factor for Anemia After Percutaneous Native Kidney Biopsy

“…The increased pulsatile stress damages small arteries and tears their endothelial and smooth muscle cells with the disruption of the vessel [10, 22, 23], which was shown in the small arteries of kidneys in a rat model of hypertension [24]. With regard to the brain, an increased PWV was significantly associated with carotid intraplaque hemorrhage, and silent microbleeds on cerebral MR [19, 25]. In the renal microcirculation, less distensible vessels and increases in the pulsation of the blood flow and pressure may be the main causes of the high rate of bleeding complications.…”