Nomogram and Carotid Risk Score for Predicting Moderate or High Carotid Atherosclerosis among Asymptomatic Elderly Recycling Volunteers

Abstract

Carotid atherosclerosis is associated with cardiovascular and cerebrovascular events. We explored an appropriate method for selecting participants without ischemic cerebrovascular disease but with various comorbidities eligible for a carotid ultrasound. This was a retrospective subgroup analysis of the carotid plaque burden from a previous study involving a vascular and cognitive survey of 956 elderly recycling volunteers (778 women and 178 men; mean age: 70.8 years). We used carotid ultrasound to detect the carotid plaque and computed the carotid plaque score (CPS). A moderate or high degree of carotid atherosclerosis (MHCA) was defined as CPS > 5 and was observed in 22% of the participants. The CPS had positive linear correlations with age, systolic blood pressure, and fasting glucose. We stratified the participants into four age groups: 60–69, 70–74, 75–79, and ≥80 years. Multivariable analysis revealed that significant predictors for MHCA were age, male sex, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, and a nonvegetarian diet. Coronary artery disease and advanced age were the two strongest predictors. We chose the aforementioned seven significant predictors to establish a nomogram for MHCA prediction. The area under the receiver operating characteristic curve in internal validation with 10-fold cross-validation and the classification accuracy of the nomogram were 0.785 and 0.797, respectively. We presumed people who have a ≥50% probability of MHCA warranted a carotid ultrasound. A flowchart table derived from the nomogram addressing the probabilities of all models of combinations of comorbidities was established to identify participants who had a probability of MHCA ≥ 50% (corresponding to a total nomogram score of ≥15 points). We further established a carotid risk score range from 0 to 17 comprising the seven predictors. A carotid risk score ≥ 7 was the most optimal cutoff value associated with a probability of MHCA ≥ 50%. Both total nomogram score ≥ 15 points and carotid risk score ≥ 7 can help in the rapid identification of individuals without stroke but who have a ≥50% probability of MHCA—these individuals should schedule a carotid ultrasound.

Validity and Reliability of Point-of-Care Ultrasound for Detecting Moderate- or High-Grade Carotid Atherosclerosis in an Outpatient Department

“…No betweensex differences were noted in the sCPSs and hCPS. Thirty patients (50%) were found to have MHCA (hCPS > 5), which is consistent with our study revealing that a carotid risk score of ≥7 confers a 50% higher risk of MHCA [13]. No differences in risk factors were observed between patients with laboratory hCPSs ≤ 5 and those with laboratory hCPSs > 5 (Table 5).…”

“…For each patient presenting to the OPD, we calculated the carotid risk score, which was described in our previous study evaluating the risk of MHCA [13]. The carotid score is a composite of graded scores assigned to the following seven key risk factors (Table 1): advanced age, male sex, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease (CAD), and nonvegetarian diet.…”

“…Table 4 summarizes the carotid sonography results of all 60 patients. We previously [13] reported that a median carotid risk score of 8 indicates a ≥63.7% risk of MHCA. The median outpatient and laboratory-derived sCPS was 2 (range: 0-6), and the median laboratory-derived hCPS was 5.0 (range: 0-19.5).…”

“…The European Society of Cardiology and the European Atherosclerosis Society still regard carotid plaque as class IIa evidence in the risk stratification of cardiovascular disease [12]. We recently demonstrated that asymptomatic individuals with carotid risk scores of ≥7 had a 50% risk of moderate-grade or high-grade carotid atherosclerosis (MHCA), highlighting the need for comprehensive carotid sonography [13].…”

Predictive nomogram for coronary heart disease in patients with type 2 diabetes mellitus

“…In contrast to earlier nomogram studies, most of these studies focused on demographic factors associated with CHD ( 46 ). Some nomogram studies often obscure the classification of patients into normal and abnormal status without focusing on their specific values.…”