title: Clinical factors associated with high-risk carotid plaque features as assessed by magnetic resonance imaging in patients with established vascular disease (from the AIM-HIGH Study).
abstract: Association between clinical factors and high-risk plaque features, such as, thin or ruptured cap, intraplaque hemorrhage, presence of lipid-rich necrotic core (LRNC), and increased LRNC volume as assessed by magnetic resonance imaging (MRI), was examined in patients with established vascular disease in the Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides (AIM-HIGH) trial. A total of 214 subjects underwent carotid MRI and had acceptable image quality for assessment of plaque burden, tissue contents, and MRI-modified American Heart Association lesion type by a core laboratory. We found that 77% of subjects had carotid plaques, 52% had lipid-containing plaques, and 11% had advanced American Heart Association type-VI lesions with possible surface defect, intraplaque hemorrhage, or mural thrombus. Type-VI lesions were associated with older age (odds ratio [OR] = 2.6 per 5 years increase, p <0.001). After adjusting for age, these lesions were associated with history of cerebrovascular disease (OR = 4.1, p = 0.01), higher levels of lipoprotein(a) (OR = 2.0 per 1 SD increase, p = 0.02), and larger percent wall volume (PWV [OR = 4.6 per 1 SD increase, p <0.001]) but, were negatively associated with metabolic syndrome (OR = 0.2, p = 0.02). Presence of LRNC was associated with the male gender (OR = 3.2, p = 0.02) and PWV (OR = 3.8 per 1 SD, p <0.001); however, it was negatively associated with diabetes (OR = 0.4, p = 0.02) and high-density lipoprotein cholesterol levels (OR = 0.7 per 1 SD, p = 0.02). Increased percent LRNC was associated with PWV (regression coefficient = 0.36, p <0.001) and negatively associated with ApoA1 levels (regression coefficient = -0.20, p = 0.03). In conclusion, older age, male gender, history of cerebrovascular disease, larger plaque burden, higher lipoprotein(a), and lower high-density lipoprotein cholesterol or ApoA1 level have statistically significant associations with high-risk plaque features. Metabolic syndrome and diabetes showed negative associations in this population.
authors.affiliation: Division of Cardiology, University of Washington School of Medicine, Seattle, Washington. Electronic address: xueqiao@uw.edu.
authors.forename: Xue-Qiao
authors.initials: XQ
authors.lastname: Zhao
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Hatsukami
authors.affiliation: Department of Radiology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.affiliation: Department of Radiology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Jie
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Radiology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Balu
authors.affiliation: Division of Cardiology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Isquith
authors.affiliation: Department of Medicine, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: John R
authors.initials: JR
authors.lastname: Crouse
authors.affiliation: Libin Cardiovascular Institute of Alberta and Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Todd
authors.initials: T
authors.lastname: Anderson
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: John
authors.initials: J
authors.lastname: Huston
authors.affiliation: The Mountain-Whisper-Light Statistics, Seattle, Washington.
authors.forename: Nayak
authors.initials: N
authors.lastname: Polissar
authors.affiliation: Division of Cardiology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: Department of Radiology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Chun
authors.initials: C
authors.lastname: Yuan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies