Association between Subclavian Artery Plaques and Future Cardiovascular Events in a Hypertensive Cohort

BackgroundAtherosclerosis is one of the leading contributors to cardiovascular diseases. Subclinical atherosclerosis could occur long time before the presence of clinical symptoms and may have predictive value for future cardiovascular events. Existing carotid subclinical atherosclerotic markers have limited value.Subjects and MethodsPatients admitted to the cardiac vascular center of Beijing Tiantan Hospital due to essential hypertension were prospectively consecutively enrolled. Those with histories of coronary artery disease (CAD), cerebrovascular diseases, and significant stenosis of main arteries were excluded. Patients diagnosed with carotid and/or subclavian artery stenosis were also excluded after admission. All participants received a series of routine blood test at admission into hospital and ultrasonic examinations of bilateral carotid arteries and right subclavian artery. All data were recorded. After discharged from hospital all participants were followed up with cardiovascular events, including death, hear failure, myocardial infarction, unstable angina pectoris and stroke.Results473 participants were finally involved in the study, including 284 men and 189 women.9/473 (8.2%, 95%C.I. [5.9-11.1%] participants suffered from endpoint events, including 19(4.0%) cases of myocardial infarction (15 undergoing PCI and 5 death), 4(0.8%) heart failure (all also involved in the myocardial infarction group), 3(0.6%) ischemic stroke (1 death), and 17(3.6%) angina pectoris (7 undergoing PCI). No death due to other reasons was recorded. After the adjustment of potential risk factors based on the results of univariate analyses, the prevalence of right subclavian plaque (RSP) (OR=2.428, 95%C.I. [1.098, 5.370], p=0.028) and both carotid and subclavian plaques (MPs) (OR = 3.539, 95%C.I. [1.547, 8.096], p = 0.003) were both significantly associated with endpoint events. Globulin and albumin had significantly correlations with future events despite the atherosclerotic marker used in the regression model.ConclusionThe prevalence of right subclavian plaques was independently significantly associated with the incidence of future cardiovascular events in the cohort. Higher level of globulin and lower level of albumin tended to be predictors for future events. Combination of both right subclavian artery and carotid artery atherosclerotic plaques may have strongest predictive value for future cardiovascular events in the hypertensive cohort without clinical atherosclerotic diseases.