Carotid Plaque Composition and Prediction of Incident Atherosclerotic Cardiovascular Disease

Abstract

Background: Whether information on carotid plaque composition contributes to prediction of incident atherosclerotic cardiovascular disease (ASCVD) remains to be investigated. We determined the sex-specific added value of carotid plaque components for predicting incident ASCVD events, beyond traditional cardiovascular risk factors. Methods: Between 2007 and 2012, participants from the population-based Rotterdam Study with asymptomatic carotid wall thickening >2.5 mm on ultrasonography were invited for carotid magnetic resonance imaging. Among 1349 participants (mean age: 72 years [SD±9.3], 49.5% women) without cardiovascular disease, we assessed plaque thickness, luminal stenosis (>30%), presence of intraplaque hemorrhage, lipid-rich necrotic core, and calcification. Follow-up for ASCVD was complete until January 1, 2015. Using Cox proportional hazards models, we fitted sex-specific prediction models including traditional cardiovascular risk factors (base model). We extended the base model by single and simultaneous additions of plaque characteristics and calculated improvement of model performance by the C statistics. Results: During a median follow-up of 4.8 years, 60 men and 48 women developed ASCVD. In women, presence of intraplaque hemorrhage was associated with incident ASCVD (adjusted hazard ratio, 3.37 [95% CI, 1.81–6.25]). The C statistic (95% CI) improved from 0.73 (0.66–0.79) to 0.76 (0.70–0.83) after single addition of intraplaque hemorrhage to the base model. Simultaneous addition of plaque components, plaque thickness, and stenosis did not change the results. In men, only carotid stenosis was statistically significantly associated with incident ASCVD (adjusted hazard ratio, 1.75 [95% CI, 1.00–3.08]); yet, the association diminished after the addition of other plaque characteristics, and no improvements were observed in C statistics. Conclusions: Presence of intraplaque hemorrhage contributes to the prediction of incident ASCVD in women, beyond traditional cardiovascular risk factors, other plaque components, plaque size, and stenosis.

Reduced Diversities and Clonally Expanded Sequences of T-Cell Receptors in Patients With Essential Hypertension and Subclinical Carotid Atherosclerosis

“…Increasing evidence indicates that the CP is a characteristic manifestation of progression in atherosclerosis and a powerful predictor of cardiovascular events. 24 Interestingly, our further analysis of the TCR repertoires in the SCA group demonstrated that the patients with EH with CP had significantly lower TCR diversity indexes D50s than those in the patients without CP, despite that there is no significant change in the percentages of dominant TCRβ clones or numbers of big clones, and there were not much changes in V-J gene usages between repertoires of these 2 subgroups either. Taken together, our results indicate that abnormal T-cell responses have a significant effect on SCA in the patients with EH, especially on the formation of CP.…”

Sex Differences in Carotid Atherosclerosis: A Systematic Review and Meta-Analysis

“…From these, 235 were read in full resulting in a final selection of 60 articles. 8–67 Main reasons for exclusion were absence of reporting stratified sex analyses regarding the plaque characteristics (n=89), use of another imaging modality than prespecified (n=24), and no inclusion of a plaque variable of interest (n=24), see Figure 1. Table S2 presents the details of the final included articles.…”

“…This idea is supported by the recently published finding that especially in asymptomatic women, IPH increased the risk of atherosclerotic cardiovascular disease (hazard ratio=3.37 [95% CI, 1.81–6.25] for women versus hazard ratio=1.67 [95% CI, 0.98–2.79] for men). 53 Studies on sex-specific risks for (recurrent) stroke risk related to carotid plaque composition are still lacking, probably due to low power, which stresses the importance of the inclusion of an adequate number of both men and women in clinical trials.…”

Role of plaque imaging for identification of vulnerable patients beyond the stage of myocardial ischemia

“…Daniel et al demonstrated an association of intraplaque hemorrhage-related unstable carotid plaque features with stroke and myocardial infarction in 1,349 patients without a history of stroke or CAD with subclinical atherosclerosis. This indicates that the presence of intraplaque hemorrhage in the carotid arteries is associated with stroke and CAD development, independent of plaque size or cardiovascular risk factors (74,75).…”