Key result
Carotid plaque linked to ~66% higher CHD risk in asymptomatic patients with CAC 0.
Why the study?
Carotid artery plaque indicates increased cardiovascular risk, but its association with cardiovascular risk and incident CAC in individuals without CAC is unclear.
Does the presence of carotid artery plaque predict cardiovascular events and incident coronary artery calcium in asymptomatic individuals with a baseline CAC score of 0?
Cohort (n=2,673)
Yes
Does the presence of carotid artery plaque predict cardiovascular events and incident coronary artery calcium in asymptomatic individuals with a baseline CAC score of 0?
Hazard Ratio: 1.66 (95% CI 1.04–2.66)
In asymptomatic individuals with a CAC score of 0, the presence of carotid plaque identifies a subgroup at increased long-term risk for coronary heart disease and incident coronary calcification.
Carotid plaque was associated with higher CHD risk and incident CAC in CAC=0 adults; extends stratification but should not yet change practice.
BACKGROUND: Absence of coronary artery calcium (CAC) identifies asymptomatic individuals at low cardiovascular disease risk. Carotid artery plaque is a marker of increased risk, but its association with cardiovascular risk and incident CAC in people without CAC is unclear. METHODS: Multi-Ethnic Study of Atherosclerosis participants with CAC score of 0 at enrollment who also underwent carotid plaque measurement using B-mode ultrasonography were prospectively followed for incident coronary heart disease, stroke, and cardiovascular disease events, and CAC (score >0 on up to 3 serial computed tomography scans). The association of carotid plaque presence and plaque score (Ln[score+1]) at baseline with cardiovascular events and incident CAC was evaluated with Cox proportional hazards regression models adjusted for demographics, risk factors, and statin use. RESULTS: Among these 2673 participants (58 years, 64% women, 34% White, 30% Black, 24% Hispanic, and 12% Chinese), carotid plaque at baseline was observed in 973 (36%) and the median plaque score (range, 1-12) among those with plaque was 1. A total of 79 coronary heart disease, 80 stroke, and 151 cardiovascular disease events were observed during 16.1 years of follow-up. Carotid plaque presence and plaque score were independently associated with coronary heart disease risk (HRs, 1.66 [95% CI, 1.04-2.66]; and 1.48 [95% CI, 1.01-2.17], respectively) but not with stroke and cardiovascular disease risk. A total of 973 (36.4%) participants developed CAC over the evaluation period (median 9.3 years). Carotid plaque presence and plaque score were independently associated with incident CAC (HRs, 1.34 [95% CI, 1.18-1.54]; and 1.37 [95% CI, 1.21-1.54]), respectively. CONCLUSIONS: The presence and extent of carotid plaque are associated with long-term coronary heart disease risk and incident CAC among middle-aged asymptomatic individuals with an initial CAC score of 0.
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Mehta et al. (2021) conducted a cohort in Absent coronary calcification (n=2,673). Carotid artery plaque vs. Absence of carotid artery plaque was evaluated on Incident coronary heart disease (CHD) (HR 1.66, 95% CI 1.04, 2.66). The presence of carotid plaque was independently associated with a 66% increased risk of incident coronary heart disease (HR 1.66) among asymptomatic individuals with an initial coronary artery calcium score of 0.
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