Prevalence and Vascular Distribution of Multiterritorial Atherosclerosis Among Community-Dwelling Adults in Southeast China

Yuesong Pan, Jing Jing, Xueli Cai, Zening Jin, Suying Wang, Yilong Wang, Chunlai Zeng, Xia Meng, Jiansong Ji, Long Li, Lingchun Lyu, Zhe Zhang, Lerong Mei, Hao Li, Shan Li, Tiemin Wei, Yongjun Wang, Yuesong Pan, Jing Jing, Xueli Cai, Zening Jin, Suying Wang, Yilong Wang, Chunlai Zeng, Xia Meng, Jiansong Ji, Long Li, Lingchun Lyu, Zhe Zhang, Lerong Mei, Hao Li, Shan Li, Tiemin Wei, Yongjun Wang

Abstract

Importance: Data are limited on the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in community populations.

Objective: To investigate the prevalence and vascular distribution of multiterritorial atherosclerotic plaque and stenosis in older, community-dwelling populations in China.

Design, setting, and participants: This cross-sectional study was based on the baseline survey from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study, a population-based prospective cohort study that enrolled community-dwelling adults aged 50 to 75 years based on cluster sampling from 6 villages and 4 living communities of Lishui city in southeast China. Data were collected from May 2017 to September 2019 and analyzed from September to November 2021.

Main outcomes and measures: Atherosclerotic plaque and stenosis at baseline were assessed in multiple vascular territories. Brain vessel wall magnetic resonance imaging (MRI) for intracranial and extracranial arteries; computed tomography angiography (CTA) for coronary, subclavian, aorta, renal, and iliofemoral arteries; and ankle-brachial index for peripheral arteries were performed at baseline survey. The extent of atherosclerosis was assessed according to the number of these 8 vascular sites affected, and polyvascular lesions were defined as at least 2 affected sites.

Results: A total of 3433 of 4202 invited individuals consented to participate in the study. After excluding 366 participants with contraindications for MRI or CTA scanning, with life expectancies of 4 years of fewer, or with mental disease, a total of 3067 community-dwelling adults were enrolled. The mean (SD) age was 61.2 (6.7) years; 1640 (53.5%) were women, and 74 (2.4%) had prevalent ASCVD. Most participants (2870 [93.6%]) had atherosclerotic plaques in at least 1 vascular territory. Atherosclerotic plaques were mostly detected in the aorta (2419 [79.6%]) and iliofemoral arteries (2312 [75.8%]), followed by subclavian (1500 [49.8%]), coronary (1366 [44.9%]), extracranial (1110 [36.4%]), renal (873 [28.7%]), and intracranial (542 [17.7%]) arteries. A substantial proportion of participants (1180 [38.5%]) had arterial stenosis of 50% or greater, predominantly affecting the coronary (542 [17.8%]) and iliofemoral (527 [17.3%]) arteries. Polyvascular atherosclerotic plaque was observed in 2541 participants (82.8%), with 1436 (46.8%) with plaque affecting 4 or more vascular territories, and polyvascular stenosis was observed in 412 patients (13.4%).

Conclusions and relevance: In this study, atherosclerotic plaque was highly prevalent in the older community population in China, and a substantial proportion of individuals reach stenosis of 50% or greater.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Yongjun Wang reported receiving grants from AstraZeneca during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.. Prevalence and Vascular Distribution of…
Figure 1.. Prevalence and Vascular Distribution of Plaque and Arterial Stenosis
ABI indicates ankle-brachial index.
Figure 2.. Burden of Multiterritorial Plaque and…
Figure 2.. Burden of Multiterritorial Plaque and Arterial Stenosis by Age and Sex

References

    1. Libby P, Buring JE, Badimon L, et al. . Atherosclerosis. Nat Rev Dis Primers. 2019;5(1):56. doi:10.1038/s41572-019-0106-z
    1. Bhatt DL, Eagle KA, Ohman EM, et al. ; REACH Registry Investigators . Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA. 2010;304(12):1350-1357. doi:10.1001/jama.2010.1322
    1. Zhang Q, Wang A, Zhang S, et al. . Asymptomatic polyvascular disease and the risks of cardiovascular events and all-cause death. Atherosclerosis. 2017;262:1-7. doi:10.1016/j.atherosclerosis.2017.04.015
    1. Gepner AD, Young R, Delaney JA, et al. . Comparison of carotid plaque score and coronary artery calcium score for predicting cardiovascular disease events: the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2017;6(2):e005179. doi:10.1161/JAHA.116.005179
    1. Budoff MJ, Young R, Burke G, et al. . Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the Multi-Ethnic Study of Atherosclerosis (MESA). Eur Heart J. 2018;39(25):2401-2408. doi:10.1093/eurheartj/ehy217
    1. Böhlke M, Barcellos FC. From the 1990s to CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) trial results and beyond: does stenting have a role in ischemic nephropathy? Am J Kidney Dis. 2015;65(4):611-622. doi:10.1053/j.ajkd.2014.11.026
    1. Guo H, Kalra PA, Gilbertson DT, et al. . Atherosclerotic renovascular disease in older US patients starting dialysis, 1996 to 2001. Circulation. 2007;115(1):50-58. doi:10.1161/CIRCULATIONAHA.106.637751
    1. Qiao Y, Guallar E, Suri FK, et al. . MR imaging measures of intracranial atherosclerosis in a population-based study. Radiology. 2016;280(3):860-868. doi:10.1148/radiol.2016151124
    1. Wang Y, Zhao X, Liu L, et al. ; CICAS Study Group . Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study. Stroke. 2014;45(3):663-669. doi:10.1161/STROKEAHA.113.003508
    1. Jiang C, Zhang J, Zhu J, et al. ; CARE-II Investigators . Association between coexisting intracranial artery and extracranial carotid artery atherosclerotic diseases and ipsilateral cerebral infarction: a Chinese Atherosclerosis Risk Evaluation (CARE-II) study. Stroke Vasc Neurol. 2021;6(4):595-602. doi:10.1136/svn-2020-000538
    1. Wang X, Li W, Song F, et al. . Carotid atherosclerosis detected by ultrasonography: a national cross-sectional study. J Am Heart Assoc. 2018;7(8):e008701. doi:10.1161/JAHA.118.008701
    1. Criqui MH, Denenberg JO, Ix JH, et al. . Calcium density of coronary artery plaque and risk of incident cardiovascular events. JAMA. 2014;311(3):271-278. doi:10.1001/jama.2013.282535
    1. Bergström G, Persson M, Adiels M, et al. . Prevalence of subclinical coronary artery atherosclerosis in the general population. Circulation. 2021;144(12):916-929. doi:10.1161/CIRCULATIONAHA.121.055340
    1. Fernández-Friera L, Peñalvo JL, Fernández-Ortiz A, et al. . Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis in a middle-aged cohort: the PESA (Progression of Early Subclinical Atherosclerosis) study. Circulation. 2015;131(24):2104-2113. doi:10.1161/CIRCULATIONAHA.114.014310
    1. Pan Y, Jing J, Cai X, et al. . PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE)—a population-based prospective cohort study: rationale, design and baseline participant characteristics. Stroke Vasc Neurol. 2021;6(1):145-151. doi:10.1136/svn-2020-000411
    1. Xu L, Schooling CM, Chan WM, Lee SY, Leung GM, Lam TH. Smoking and hemorrhagic stroke mortality in a prospective cohort study of older Chinese. Stroke. 2013;44(8):2144-2149. doi:10.1161/STROKEAHA.113.001500
    1. Yang X, Li J, Hu D, et al. . Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population: the China-PAR Project (Prediction for ASCVD Risk in China). Circulation. 2016;134(19):1430-1440. doi:10.1161/CIRCULATIONAHA.116.022367
    1. Wang Z, Chen Z, Zhang L, et al. ; China Hypertension Survey Investigators . Status of hypertension in China: results from the China Hypertension Survey, 2012-2015. Circulation. 2018;137(22):2344-2356. doi:10.1161/CIRCULATIONAHA.117.032380
    1. Williams B, Mancia G, Spiering W, et al. ; ESC Scientific Document Group . 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. doi:10.1093/eurheartj/ehy339
    1. Wang L, Gao P, Zhang M, et al. . Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA. 2017;317(24):2515-2523. doi:10.1001/jama.2017.7596
    1. American Diabetes Association . Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36(suppl 1):S67-S74. doi:10.2337/dc13-S067
    1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497. doi:10.1001/jama.285.19.2486
    1. Joint Committee for the Revision of Guidelines for the Prevention and Treatment of Dyslipidemia in Chinese Adults . Guidelines for the prevention and treatment of dyslipidemia in Chinese adults (revised edition 2016). Article in Chinese. Chin Circulation J. 2016;31(10):937-953. doi:10.3969/j.issn.1000-3614.2016.10.001
    1. Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI. A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol. 2000;21(4):643-646.
    1. Fox AJ. How to measure carotid stenosis. Radiology. 1993;186(2):316-318. doi:10.1148/radiology.186.2.8421726
    1. Wu FZ, Wu MT. 2014 SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2015;9(2):e3. doi:10.1016/j.jcct.2015.01.003
    1. Rooke TW, Hirsch AT, Misra S, et al. ; American College of Cardiology Foundation Task Force; American Heart Association Task Force . Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(14):1555-1570. doi:10.1016/j.jacc.2013.01.004
    1. Bhatt DL, Steg PG, Ohman EM, et al. ; REACH Registry Investigators . International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA. 2006;295(2):180-189. doi:10.1001/jama.295.2.180
    1. Suri MF, Qiao Y, Ma X, et al. . Prevalence of intracranial atherosclerotic stenosis using high-resolution magnetic resonance angiography in the general population: the Atherosclerosis Risk in Communities Study. Stroke. 2016;47(5):1187-1193. doi:10.1161/STROKEAHA.115.011292
    1. Bergström G, Berglund G, Blomberg A, et al. . The Swedish CArdioPulmonary BioImage Study: objectives and design. J Intern Med. 2015;278(6):645-659. doi:10.1111/joim.12384
    1. Banerjee C, Chimowitz MI. Stroke caused by atherosclerosis of the major intracranial arteries. Circ Res. 2017;120(3):502-513. doi:10.1161/CIRCRESAHA.116.308441
    1. Zhai FF, Yan S, Li ML, et al. . Intracranial arterial dolichoectasia and stenosis: risk factors and relation to cerebral small vessel disease. Stroke. 2018;49(5):1135-1140. doi:10.1161/STROKEAHA.117.020130

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere