Carotid plaque burden as a measure of subclinical atherosclerosis: comparison with other tests for subclinical arterial disease in the High Risk Plaque BioImage study.
OBJECTIVE
The purpose of this study was to compare carotid plaque burden, carotid intima-media thickness (cIMT), ankle-brachial index (ABI), and abdominal aortic diameter (AAD) to coronary artery calcium score (CACS) in people without known cardiovascular disease.


BACKGROUND
The clinical utility of risk factors to predict cardiovascular events is limited. Detection of subclinical atherosclerosis by noninvasive tests such as CACS, cIMT, carotid plaque burden, AAD, and ABI may improve risk prediction above that of established risk scoring models, namely, Framingham Risk Score.


METHODS
The High Risk Plaque BioImage study investigated 6.101 asymptomatic persons and reports baseline CACS, cIMT, ABI, and AAD. In addition, we present findings from a new 3-dimensional-based ultrasound approach, where the carotid artery was investigated in cross section from proximal in the neck to as distal as possible. From the resulting 10-s video, plaque was outlined on cross-sectional images and all plaque areas were summarized into "plaque burden."


RESULTS
The mean age was 68.8 years, and 65.3% of subjects had intermediate Framingham Risk Score (6% to 20% 10-year risk). Carotid plaques were identified in 78% of cases, abnormal ABI in 10%, AAD >20 mm in 28%, and coronary calcium in 68% of participants. Carotid plaque burden was found to correlate stronger with CACS (chi-square 450, p < 0.0001) than did cIMT (chi-square 24, p < 0.0001), AAD (chi-square 2.9, p = 0.091), and ABI (chi-square 35.2, p < 0.0001).


CONCLUSIONS
In the BioImage study, a new 3-dimensional-based ultrasound method identified more carotid plaques than in previous studies. Compared to other methods, carotid plaque burden was the strongest cross-sectional predictor of CACS, and its clinical utility as predictor of future cardiovascular events is being evaluated in the BioImage study. (BioImage Study: A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population; NCT00738725).
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. henrik.sillesen@rh.dk
Henrik
H
Sillesen
Pieter
P
Muntendam
Aram
A
Adourian
Robert
R
Entrekin
Mario
M
Garcia
Erling
E
Falk
Valentin
V
Fuster
D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D058070:Asymptomatic Diseases; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D002641:Chicago; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D005431:Florida; D006801:Humans; D021621:Imaging, Three-Dimensional; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler; D061205:Vascular Calcification / Q000175:diagnosis