Key result
The presence of carotid plaque in hypertensive patients was significantly associated with a higher prevalence of ischemic stroke (11.8% vs 5.8%, P<0.001), and adding it to traditional risk models improved risk stratification.
Why the study?
ISCVD risk prediction models based on traditional risk factors are limited, and the value of adding carotid plaque to risk stratification needed evaluation.
Does adding carotid plaque assessment to traditional risk stratification improve the prediction of ischemic cardiovascular disease in patients with hypertension?
Cross-Sectional (n=3,998)
No
Does adding carotid plaque assessment to traditional risk stratification improve the prediction of ischemic cardiovascular disease in patients with hypertension?
Absolute Event Rate: 11.8% vs 5.8%
p-value: p=<0.001
Adding carotid plaque assessment to traditional risk stratification significantly improves the identification of ischemic stroke risk and leads to meaningful risk reclassification in hypertensive patients.
Does not support routine carotid plaque assessment in hypertension; leaves open prospective validation of improved stroke prediction.
Background: Ischemic cardiovascular disease (ISCVD) is a massive public health problem. ISCVD risk prediction models based on traditional risk factors as predictors is limited. Carotid atherosclerosis plays a fundamental value in the occurrence of ISCVD. The aim of this study was to evaluate the value of risk stratification plus carotid plaque improving the prediction of ISCVD. Methods: Between June 2016 and June 2017, 3998 subjects with hypertension were prospectively recruited and completed traditional risk factors survey and carotid ultrasound measurements in Anzhen Hospital, Beijing, China. Results: A total of 2010 (50.3%) subjects were detected carotid plaque. Among patients free from ISCVD (n=3479), there were 884 patients (25.4%) at high risk for ISCVD, and 868 (25.0%), 1727 (49.6%) was classified as intermediate risk or low risk according to Chinese cardiovascular risk score chart. The detected rate of carotid plaque was 64.7%, 53.7%, and 38.5% among patients at high risk to low risk, respectively. Carotid plaques and risk stratification alone or in combination were significantly associated with ischemic stroke, and negatively correlated with coronary heart disease (all P>0.05). Adding carotid plaque to risk stratification, the ischemic stroke prevalence increased from 5.3% to 9.1% in the low-risk group (P=0.001), 5.4% to 12.3% in the intermediate-risk group (P<0.001) and 8.2% to 14.4% than in the high-risk group (P=0.004). Intermediate risk plus carotid plaque (443/3998) were reclassified to a new high-risk group, high risk only (749/3998) and low risk plus carotid plaque (353/3998) were reclassified to a new intermediate risk group; and intermediate risk only (553/3998) were reclassified to a new low risk group. According to the reclassification, there were 1635 subjects (40.9%) at high risk, and 1102 (27.6%), 1261 (31.5%) was classified as intermediate risk or low risk. Conclusions: Carotid plaque has an important position as it plus risk stratification may improve the risk assessment of ischemic stroke and have resulted in reclassification.
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Zuo et al. (2021) conducted a cross-sectional in Hypertension (n=3,998). Presence of carotid plaque vs. Absence of carotid plaque was evaluated on Prevalence of ischemic stroke (p=<0.001). The presence of carotid plaque in hypertensive patients was significantly associated with a higher prevalence of ischemic stroke (11.8% vs 5.8%, P<0.001), and adding it to traditional risk models improved risk stratification.
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