Key result
Asymptomatic carotid plaque with ≥3 risk factors is linked to ~155% higher stroke risk.
Why the study?
The effectiveness of incorporating simple carotid ultrasound markers into modifiable conventional vascular risk factors to identify high-risk stroke populations was not established.
Does incorporating asymptomatic carotid atherosclerosis assessed by ultrasound into conventional vascular risk factor models improve the identification of high-risk stroke populations?
Cohort (n=3,506)
Does incorporating asymptomatic carotid atherosclerosis assessed by ultrasound into conventional vascular risk factor models improve the identification of high-risk stroke populations?
Effect estimate: HR 2.55 (95% CI 1.62-4.00)
Adding carotid ultrasound markers of asymptomatic atherosclerosis to conventional risk factors improves the identification of individuals at high risk for stroke, particularly in older adults with fewer conventional risk factors.
May refine stroke risk stratification in older adults with few conventional factors; leaves open whether ultrasound integration improves outcomes.
BACKGROUND: To assess the effectiveness of incorporating simple carotid ultrasound markers into modifiable conventional vascular risk factors (C-VRFs) on identifying the high-risk stroke population. METHODS: A community-based cohort study involving 3,506 participants (mean [standard deviation] age: 61.3 [12.8] years; 41.8% male), all of whom were free of stroke and atrial fibrillation at baseline, underwent carotid ultrasound assessment. The asymptomatic carotid atherosclerosis (ACS) was assessed by detecting increased carotid intima–media thickness and plaques with or without stenosis. The new stroke events occurring during a 5.5-year follow-up were recorded. Nomograms for stroke probability by adding ACS to C-VRFs constructed models were developed and validated. RESULTS: Integrating ACS into C-VRF models further improved the models’ performance for stroke prediction. Neither additive nor multiple interactions of ACS and C-VRFs existed. While comparing with group of none/mild ACS and C-VRFs < 3, the risk of total stroke in the group with plaque and C-VRFs ≥ 3 increased by 2.6 times (hazard ratios [HRs]: 2.55, 95% confidence interval [CI]: 1.62–4.00) after adjusting for age and gender. The elevated stroke risk in the group of plaques with C-VRFs < 3 (HR: 1.88, 95% CI: 1.17–3.01) was equivalent to that with none/mild ACS and C-VRFs ≥ 3 (HR: 1.85, 95% CI: 1.12–3.00). In the group with C-VRFs < 3, 42.5% subjects had plaques, and 84% of those plaque-positive subjects were ≥ 60 years old. Moreover, the prevalence of nonstenosis and intermediate stenosis plaques was the highest, with the largest new stroke event occurring during the follow-up period. CONCLUSION: Adding ACS to multiple C-VRFs may improve high-risk stroke individual identification in the general population. While this modality may overlook the high-risk stroke population having plaques with C-VRFs < 3, in older adults.
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Fang et al. (2025) conducted a cohort in Stroke (n=3,506). Carotid ultrasound assessment for asymptomatic carotid atherosclerosis (ACS) vs. Conventional vascular risk factors (C-VRFs) alone was evaluated on New stroke events (HR 2.55, 95% CI 1.62-4.00). Adding asymptomatic carotid atherosclerosis to conventional risk factors improved stroke prediction, with plaque and ≥3 risk factors increasing stroke risk (HR 2.55; 95% CI 1.62-4.00).
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