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Atherosclerosis. 2018 Sep;276:195-202. doi: 10.1016/j.atherosclerosis.2018.06.005. Epub 2018 Jun 12.

Ultrasound carotid plaque features, cardiovascular disease risk factors and events: The Multi-Ethnic Study of Atherosclerosis.

Author information

1
Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA. Electronic address: ccm@medicine.wisc.edu.
2
Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
3
Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA.
4
Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA.
5
Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
6
Departments of Pathology & Laboratory Medicine, Biochemistry Larner College of Medicine, University of Vermont, 360 South Park Drive, Colchester, VT, 05446, USA.
7
Department of Environmental & Occupational Health Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
8
Department of Biostatistics, University of Washington, 6200 NE, 74(th)Street, Seattle, WA, 98115, USA.

Abstract

BACKGROUND AND AIMS:

It is not known if ultrasound carotid plaque features are associated with cardiovascular disease (CVD) risk factors or if they predict future CVD events.

METHODS:

We measured total carotid plaque area (TPA) and grayscale plaque features (grayscale median, black areas, and discrete white areas) by B-mode carotid ultrasound among 2205 participants who participated in the first (baseline) visit of the Multi-Ethnic Study of Atherosclerosis. Multivariable linear regression was used to examine relationships between ultrasound plaque features and CVD risk factors at baseline. Cox proportional hazards models were used to assess if TPA, grayscale features, and carotid plaque score (number of arterial segments with a plaque) could predict incident coronary heart disease and cerebrovascular disease events over a mean follow-up of 13.3 years.

RESULTS:

Participants were mean (standard deviation [SD]) 65.4 (9.6) years, 49% male, 39% White, 11% Chinese, 28% Black, and 22% Hispanic. Mean TPA 27.7 (24.7) mm2, but no grayscale plaque features, was associated with CVD risk factors. In fully adjusted models, TPA but no grayscale features predicted incident coronary heart disease (CHD) events (HR 1.23; 95%CI 1.11-1.36; p<0.001), however, C-statistics for CHD were similar to carotid plaque score but less than for coronary artery calcium (CAC) scoring. Neither TPA nor grayscale features independently predicted cerebrovascular events.

CONCLUSIONS:

In middle-aged adults free of known cardiovascular disease, TPA but not grayscale plaque features was associated with CVD risk factors and predicted incident CHD events. For CHD, prediction indices for TPA were similar to carotid plaque score but less than for CAC.

KEYWORDS:

Cardiovascular disease; Carotid ultrasound; Echogenicity; Plaque

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