title: Femoral and Carotid Subclinical Atherosclerosis Association With Risk Factors and Coronary Calcium: The AWHS Study.
abstract: BACKGROUND
  Early subclinical atherosclerosis has been mainly researched in carotid arteries. The potential value of femoral arteries for improving the predictive capacity of traditional risk factors is an understudied area.
  
  
  OBJECTIVE
  This study sought to evaluate the association of subclinical carotid and femoral plaques with risk factors and coronary artery calcium score (CACS) in middle-aged men.
  
  
  METHODS
  Participants (n = 1,423) of the AWHS (Aragon Workers' Health Study), a study designed to assess cardiovascular risk and subclinical atherosclerosis in a cohort of middle-aged men (40 to 59 years of age), underwent carotid and femoral ultrasound plus noncontrast coronary computed tomography. Subclinical atherosclerosis was defined as the presence of any plaque in carotid or femoral arteries and/or CACS ≥1. Logistic regression models were used to estimate the prevalence of atherosclerosis adjusted for risk factors and age, to evaluate the association of atherosclerosis with risk factors, and to calculate areas under the receiver-operating characteristic curves for the presence of positive CACS.
  
  
  RESULTS
  Subclinical atherosclerosis was found in 72% of participants. Plaques were most common in femoral arteries (54%), followed by coronary calcification (38%) and carotid plaques (34%). Association of atherosclerosis with risk factors was stronger in femoral arteries than carotid or coronary arteries. The area under the receiver-operating characteristic curve for prediction of positive CACS increased from 0.665 when considering only risk factors (dyslipidemia, current smoking, hypertension, diabetes, and age) to 0.719 when adding femoral and carotid plaques (p < 0.001). In this model, the femoral odds ratio (2.58) exceeded the carotid odds ratio (1.80) for prediction of positive CACS.
  
  
  CONCLUSIONS
  Subclinical atherosclerosis was highly prevalent in this middle-aged male cohort. Association with risk factors and positive CACS was stronger in femoral than carotid arteries. Screening for femoral plaques may be an appealing strategy for improving cardiovascular risk scales and predicting coronary disease.
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red - Epidemiología y Salud Pública (CIBERESP), Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Department of Epidemiology, St. Louis University, St. Louis, Missouri.
authors.forename: Martín
authors.initials: M
authors.lastname: Laclaustra
authors.affiliation: Instituto Aragonés de Ciencias de Salud, IIS Aragón, Zaragoza, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Casasnovas
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Ortiz
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Mount Sinai School of Medicine, New York, New York. Electronic address: valentin.fuster@mountsinai.org.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.affiliation: Instituto Aragonés de Ciencias de Salud, IIS Aragón, Zaragoza, Spain.
authors.forename: Monserrat
authors.initials: M
authors.lastname: León-Latre
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Hospital Universitario La Princesa, Madrid, Spain.
authors.forename: Luis J
authors.initials: LJ
authors.lastname: Jiménez-Borreguero
authors.affiliation: Instituto Aragonés de Ciencias de Salud, IIS Aragón, Zaragoza, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pocovi
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
authors.forename: Yamilee
authors.initials: Y
authors.lastname: Hurtado-Roca
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.
authors.forename: José M
authors.initials: JM
authors.lastname: Ordovas
authors.affiliation: Instituto Aragonés de Ciencias de Salud, IIS Aragón, Zaragoza, Spain; Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain.
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Jarauta
authors.affiliation: Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Ibañez
authors.affiliation: Instituto Aragonés de Ciencias de Salud, IIS Aragón, Zaragoza, Spain; Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Civeira
mesh_terms: D000328:Adult; D002118:Calcium / Q000378:metabolism*; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000378:metabolism*; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D002118:Calcium
keywords: cohort; computed tomography; risk assessment; ultrasonography