Risk factors for carotid plaque progression after optimising the risk factor treatment: substudy results of the Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the carotid Bifurcation Plaque Study (ANTIQUE)

David Školoudík, Petra Kešnerová, Tomáš Hrbáč, David Netuka, Jaroslav Vomáčka, Kateřina Langová, Roman Herzig, Tomáš Belšan, David Školoudík, Petra Kešnerová, Tomáš Hrbáč, David Netuka, Jaroslav Vomáčka, Kateřina Langová, Roman Herzig, Tomáš Belšan

Abstract

Background and aim: Carotid plaque progression contributes to increasing stroke risk. The study aims to identify factors influencing carotid plaque thickness progression after changing the preventive treatment to the 'treating arteries instead of risk factors' strategy, that is, change in treatment depending on the progression of atherosclerosis.

Methods: The study participants who completed sonographic controls over the course of 3 years were enrolled to the analysis. Duplex sonography of cervical arteries was performed in 6-month intervals with measurement of carotid plaque thickness. Plaque thickness measurement error (σ) was set as 3 SD. Only evidently stable and progressive plaques (defined as plaque thickness difference between initial and final measurements of ˂σ and >2σ, respectively) were included to analysis. Univariate and multivariate logistic regression analysis was performed to identify factors influencing plaque progression.

Results: A total of 1391 patients (466 males, age 67.2±9.2 years) were enrolled in the study. Progressive plaque in at least one carotid artery was detected in 255 (18.3%) patients. Older age, male sex, greater plaque thickness, coronary heart disease, vascular surgery/stenting history and smoking were more frequently present in patients with progressive plaque (p˂0.05 in all cases). Multivariate logistic regression analysis identified only the plaque thickness (OR 1.850 for left side, 95% CI 1.398 to 2.449; and OR 1.376 for right side, 95% CI 1.070 to 1.770) as an independent factor influencing plaque progression.

Conclusion: Carotid plaque thickness corresponding to stenosis severity is the only independent risk factor for plaque thickness progression after optimising the prevention treatment.

Trial registration number: NCT02360137.

Keywords: atherosclerosis; plaque; stenosis; ultrasonography.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Measurement of atherosclerotic plaque thickness in the B-mode transverse section of the internal carotid artery.

References

    1. Flaherty ML, Kissela B, Khoury JC, et al. . Carotid artery stenosis as a cause of stroke. Neuroepidemiology 2013;40:36–41. 10.1159/000341410
    1. Ooi YC, Gonzalez NR. Management of extracranial carotid artery disease. Cardiol Clin 2015;33:1–35. 10.1016/j.ccl.2014.09.001
    1. Phan TG, Beare RJ, Jolley D, et al. . Carotid artery anatomy and geometry as risk factors for carotid atherosclerotic disease. Stroke 2012;43:1596–601. 10.1161/STROKEAHA.111.645499
    1. Saba L, Yuan C, Hatsukami TS, et al. . Carotid artery wall imaging: perspective and guidelines from the ASNR vessel wall imaging study group and expert consensus recommendations of the american society of neuroradiology. AJNR Am J Neuroradiol 2018;39:E9–31. 10.3174/ajnr.A5488
    1. Imparato AM, Riles TS, Gorstein F. The carotid bifurcation plaque: pathologic findings associated with cerebral ischemia. Stroke 1979;10:238–45. 10.1161/01.STR.10.3.238
    1. Redgrave JNE, Lovett JK, Gallagher PJ, et al. . Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: the oxford plaque study. Circulation 2006;113:2320–8. 10.1161/CIRCULATIONAHA.105.589044
    1. Kešnerová P, Vizlayová D, koloudík D. Detection of unstable carotid plaque in ischemic stroke prevention. Cesk Slov Neurol N 2018;81:378–91.
    1. Zhu G, Hom J, Li Y, et al. . Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovasc Diagn Ther 2020;10:1048–67. 10.21037/cdt.2020.03.10
    1. von Reutern G-M, Goertler M-W, Bornstein NM, et al. . Grading carotid stenosis using ultrasonic methods. Stroke 2012;43:916–21. 10.1161/STROKEAHA.111.636084
    1. Rundek T, Arif H, Boden-Albala B, et al. . Carotid plaque, a subclinical precursor of vascular events: the northern manhattan study. Neurology 2008;70:1200–7. 10.1212/01.wnl.0000303969.63165.34
    1. Sillesen H, Sartori S, Sandholt B, et al. . Carotid plaque thickness and carotid plaque burden predict future cardiovascular events in asymptomatic adult Americans. Eur Heart J Cardiovasc Imaging 2018;19:1042–50. 10.1093/ehjci/jex239
    1. Chen P-C, Jeng J-S, Hsu H-C, et al. . Carotid atherosclerosis progression and risk of cardiovascular events in a community in Taiwan. Sci Rep 2016;6:25733. 10.1038/srep25733
    1. Spence JD, Hackam DG. Treating arteries instead of risk factors: a paradigm change in management of atherosclerosis. Stroke 2010;41:1193–9. 10.1161/STROKEAHA.110.577973
    1. Mancia G, Fagard R, Narkiewicz K. Practice guidelines for the management of arterial hypertension of the european society of hypertension (ESH) and the european society of cardiology (ESC): ESH/ESC task force for the management of arterial hypertension. J Hypertension 2013;2013:1925–38.
    1. Kumar R, Nandhini LP, Kamalanathan S, et al. . Evidence for current diagnostic criteria of diabetes mellitus. World J Diabetes 2016;7:396. 10.4239/wjd.v7.i17.396
    1. Stone NJ, Robinson JG, Lichtenstein AH, et al. . 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the american college of cardiology/american heart association task force on practice guidelines. Circulation 2014;129:S1–45. 10.1161/01.cir.0000437738.63853.7a
    1. Spence JD. Management of asymptomatic carotid stenosis. Ann Transl Med 2020;8:1262. 10.21037/atm-20-975
    1. Korcarz CE, DeCara JM, Hirsch AT, et al. . Ultrasound detection of increased carotid intima-media thickness and carotid plaque in an office practice setting: does it affect physician behavior or patient motivation? J Am Soc Echocardiogr 2008;21:1156–62. 10.1016/j.echo.2008.05.001
    1. Näslund U, Ng N, Lundgren A, et al. . Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. Lancet 2019;393:133–42. 10.1016/S0140-6736(18)32818-6
    1. ÚZIS CR. Overall mortality; ECHI, 2019. Available:
    1. WHO . Who mortality database, 2019. Available: [Accessed 04 Apr 2021].
    1. Truthmann J, Busch MA, Scheidt-Nave C, et al. . Modifiable cardiovascular risk factors in adults aged 40-79 years in Germany with and without prior coronary heart disease or stroke. BMC Public Health 2015;15:701. 10.1186/s12889-015-1929-5
    1. Perk J, De Backer G, Gohlke H, et al. . European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33:1635–701. 10.1093/eurheartj/ehs092
    1. Pérez HA, Adeoye AO, Aballay L, et al. . An intensive follow-up in subjects with cardiometabolic high-risk. Nutr Metab Cardiovasc Dis 2021;31:2860–9. 10.1016/j.numecd.2021.06.011
    1. Spence JD, Eliasziw M, DiCicco M, et al. . Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. Stroke 2002;33:2916–22. 10.1161/01.str.0000042207.16156.b9
    1. Spence JD, Coates V, Li H, et al. . Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. Arch Neurol 2010;67:180–6. 10.1001/archneurol.2009.289
    1. European Carotid Surgery Trialists' Collaborative Group . Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC european carotid surgery trial (ECST). The Lancet 1998;351:1379–87. 10.1016/S0140-6736(97)09292-1
    1. Bland JM, Altman DG. Correlation in restricted ranges of data. BMJ 2011;342:d556. 10.1136/bmj.d556
    1. Spence JD, Solo K. Resistant atherosclerosis: the need for monitoring of plaque burden. Stroke 2017;48:1624–9. 10.1161/STROKEAHA.117.017392

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir