Carotid Atherosclerosis as an Additional Predictor of Cardiovascular Risk: Analysis Using the Score in the Population Aged 40–64 Years

Highlights Total carotid plaque thickness ≥ 1.4 mm (TPT14) and the maximum stenosis percentage > 25% showed added prognostic information in assessing the 10-year risk of fatal cardiovascular events in the population of apparently healthy men aged 40–64 years. Integration of the TPT14 parameter into the SCORE significantly changed the risk structure and improves risk stratification, especially in clinically significant ranges where the transition between moderate, high and very high risk categories may influence medical decision-making. No effect of ultrasound parameters on cardiovascular risk was found in women, which is probably due to the peculiarities of the risk structure and the lower prevalence of carotid atherosclerosis in this population. Absract Aim. To research predictive value of ultrasound carotid plaque parameters in assessing 10-year cardiovascular risk (CVR) once added to SCORE in apparently healthy population and developing a risk recalculation table for actual parameters. Methods. We analyzed data from 777 members of representative sample of unorganized population aged 40–64 years, formed as part of the ESSE-RF study (299 men, 478 women). Cardiac screening, carotid ultrasound, CVR assessment by SCORE, and 10-year prospective follow-up were performed. All participants signed a voluntary informed consent to participate in the study. Statistical analysis included Weibull regression, estimation of the added value of parameters (likelihood ratio, AIC, AUC), calibration, risk recalculation by relative risk and Bayesian methods, reclassification analysis (NRI). Results. In men, total carotid plaque thickness ≥ 1.4 mm and maximum stenosis > 25% showed independent prognostic value once added to SCORE. When integrating the first parameter into SCORE, risk reclassification affected 54.9% of men (NRI = 0.41; p = 0.022), especially in intermediate categories (moderate, high risk). Specifically, the risk category increased in 22% and decreased in 32.9% of men. In women, there was no significant relationship between ultrasound parameters and CVR, assumed due to the risk distribution features and low overall risk level. The table of SCORE-specific CVR recalculation was developed based on total plaque thickness ≥ 1.4 mm parameter. Conclusion. The study emphasizes importance of taking subclinical atherosclerosis into account when assessing CVR, especially in men with intermediate SCORE values. Adding specific ultrasound parameters improves risk stratification and can influence clinical decisions. The proposed risk recalculation system provides a practical tool that facilitates personification of therapeutic and preventive measures. Overall, the work demonstrates potential of ultrasound atherosclerosis parameters in improving existing risk assessment methods and may be of particular interest for development of personalized approaches to CVD prevention, however, additional studies are needed to confirm the properties of the model proposed.