Calcified carotid artery plaques predict cardiovascular outcomes in the elderly.
BACKGROUND
Identifying plaque composition using ultrasound may aid in stratifying patients at high risk for cardiovascular disease (CVD). Calcification is an integral part of plaque progression and may contribute to plaque vulnerability. We investigated the ability of calcified carotid plaques identified using carotid ultrasound to predict cardiovascular outcomes in older adults.


METHODS
Participants included 187 hypertensive and 187 normotensive adults undergoing a duplex scan to identify the presence of calcified carotid plaques. Hypertensive participants received either blood pressure treatment or placebo, and all participants were followed for incident cardiovascular events and death for a maximum of 11 years.


RESULTS
The untreated hypertensive group was significantly associated with a higher time-to-any CVD event [relative risk (RR) 2.97, 95% confidence interval (CI) 2.03-4.35, P < 0.0001] and mortality (RR 3.11, 95% CI 1.92-5.04, P < 0.0001) when compared to the normotensive group. Participants with calcified carotid plaques had higher cardiovascular event rates (RR 6.22, 95% CI 1.97-19.6, P = 0.0018) and mortality (RR 6.30, 95% CI 1.55-25.7, P = 0.010) when compared to those without plaque. After controlling for age, male sex, blood pressure status, glucose, and IMT, the presence of calcified carotid plaques remained predictive of CVD events (RR 2.35, 95% CI 1.5-3.8, P = 0.0005) and mortality (RR 2.72, 95% CI 1.4-5.2, P = 0.0021).


CONCLUSIONS
Calcified carotid plaques may predict mortality and cardiovascular outcomes independent of traditional CVD risk factors and may serve as an additional CVD risk assessment in the elderly.
aSchool of Health Sciences, Saint Francis University, Loretto bAllegheny Health Network, Allegheny General Hospital, Pittsburgh cDepartment of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA *Trina Thompson and Kelly J. Shields contributed equally to the completion of this work.
Trina
T
Thompson
Kelly J
KJ
Shields
Emma
E
Barinas-Mitchell
Anne
A
Newman
Kim
K
Sutton-Tyrrell
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002114:Calcinosis; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality*; D059168:Carotid Intima-Media Thickness; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality*; D012307:Risk Factors