Carotid Plaque Burden Is Shown To Predict Cardiovascular Death
SAN FRANCISCO — Plaques in the carotid arteries were associated with an increased risk of death due to cardiovascular disease in a prospective 10-year study of 2,651 people chosen randomly from the general population.
Previous data have shown a significant association between carotid artery plaque burden and risk of cardiovascular death in people with known cardiovascular disease. The current study shows that carotid artery plaque burden provides independent prognostic information in the general population as well, Marina Krintel Christensen, M.D., said in a poster presentation at the annual meeting of the American Society of Hypertension.
The investigators examined the carotid arteries of apparently healthy people aged 41, 51, 61, or 71 years in 1993 and 1994 by using B-mode ultrasound. Ten years later, the investigators followed up by recording the number and causes of death.
At baseline, they found carotid artery plaques in 724 subjects—423 men and 301 women, said Dr. Christensen and her associates at Glostrup (Denmark) University Hospital.
The presence of plaques was linked to a 57% increase in the risk of cardiovascular death over the 10-year period after adjustment for conventional risk factors for cardiovascular death including age, cholesterol levels, smoking status, fasting glucose levels, gender, mean arterial pressure, pulse pressure, and prior cardiovascular disease.
Gender and smoking status did not alter the relationship between carotid artery plaques and cardiovascular death.
The study suggests that carotid artery plaques are another risk factor that might be assessed in deciding whether and how aggressively to treat patients with high blood pressure, Dr. Christensen said in an interview during the poster session. Conventional risk factors such as age, cholesterol, and smoking status provide plenty of information to guide management in most patients, but carotid ultrasound might be worth the added expense to look for plaques in borderline patients if physicians are having difficulty deciding on antihypertensive therapy, she said.
After 10 years, 3% of people with no plaques at baseline had died of cardiovascular causes, compared with 7% of people with one or two plaques and 19% of people with more than two plaques.
In men, the cardiovascular mortality rate at 10 years was 4% in those with no plaques at baseline, 7% in those with up to two plaques, and 25% in those with more than two plaques. In women, cardiovascular death rates were 1% with no plaques, 6% with up to two plaques, and 11% with more than two plaques.
