Key result
Maximum carotid stenosis was the strongest independent predictor of vulnerable plaque features such as lipid-rich necrotic core (p < 0.001) in medically treated asymptomatic patients, whereas modifiable risk factors showed no correlation.
Why the study?
While MRI shows an association between atherosclerotic risk factors and plaque vulnerability in naive patients, whether this association persists in medically treated asymptomatic patients was unknown.
Do well-controlled modifiable risk factors or maximum stenosis correlate with carotid plaque vulnerability on MRI in medically treated asymptomatic patients?
Cross-Sectional (n=260)
No
Do well-controlled modifiable risk factors or maximum stenosis correlate with carotid plaque vulnerability on MRI in medically treated asymptomatic patients?
Effect estimate: B 0.19 (95% CI 0.17-0.22)
p-value: p=<0.001
In medically treated asymptomatic patients with carotid atherosclerosis, maximum stenosis, rather than well-controlled modifiable risk factors, is the strongest predictor of plaque vulnerability on MRI.
No association between traditional RFs and carotid plaque vulnerability on MRI in treated patients; leaves open whether optimized therapy modifies these links.
MRI can assess plaque composition and has demonstrated an association between some atherosclerotic risk factors (RF) and markers of plaque vulnerability in naive patients. We aimed at investigating this association in medically treated asymptomatic patients. This is a cross-sectional interim analysis (August 2013–September 2016) of a single center prospective study on carotid plaque vulnerability (MAGNETIC study). We recruited patients with asymptomatic carotid atherosclerosis (US stenosis > 30%, ECST criteria), receiving medical treatments at a tertiary cardiac rehabilitation. Atherosclerotic burden and plaque composition were quantified with 3.0 T MRI. The association between baseline characteristics and extent of lipid-rich necrotic core (LRNC), fibrous cap (CAP) and intraplaque hemorrhage (IPH) was studied with multiple regression analysis. We enrolled 260 patients (198 male, 76%) with median age of 71-y (interquartile range: 65–76). Patients were on antiplatelet therapy, ACE-inhibitors/angiotensin receptor blockers and statins (196–229, 75–88%). Median LDL-cholesterol was 78 mg/dl (59–106), blood pressure 130/70 mmHg (111–140/65–80), glycosylated hemoglobin 46 mmol/mol (39–51) and BMI 25 kg/m 2 (23–28); moreover, 125 out of 187 (67%) patients were ex-smokers. Multivariate analysis of a data-set of 487 (94%) carotid arteries showed that a history of hypercholesterolemia, diabetes, hypertension or smoking did not correlate with LRNC, CAP or IPH. Conversely, maximum stenosis was the strongest independent predictor of LRNC, CAP and IPH (p < 0.001). MRI assessment of plaque composition in patients on treatment for asymptomatic carotid atherosclerosis shows no correlation between plaque vulnerability and the most well-controlled modifiable RF. Conversely, maximum stenosis exhibits a strong correlation with vulnerable features despite treatment.
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Catalano et al. (2021) conducted a cross-sectional in Asymptomatic carotid atherosclerosis (n=260). Maximum carotid stenosis was evaluated on Association between maximum stenosis and lipid-rich necrotic core (LRNC) extent (B 0.19, 95% CI 0.17-0.22, p=<0.001). Maximum carotid stenosis was the strongest independent predictor of vulnerable plaque features such as lipid-rich necrotic core (p < 0.001) in medically treated asymptomatic patients, whereas modifiable risk factors showed no correlation.
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