Key result
Cardiometabolic risk factors are linked to lower carotid plaque GSM, reflecting greater plaque vulnerability.
Why the study?
The contribution of modifiable and non-modifiable cardiovascular risk factors to vulnerable carotid plaque morphology measured by low gray-scale median index was unclear.
Cross-Sectional (n=1,030)
No
Mean Difference: -8.02
p-value: p=0.02
Glycemic and lipid metabolism factors, particularly in men, are associated with vulnerable, low-density carotid plaque morphology, while glucose-lowering medications may promote a more stable plaque phenotype.
Should not yet change practice; hypothesis-generating for metabolic modulation of carotid plaque stability.
Low Gray-Scale Median (GSM) index is an ultrasonographic parameter of soft, lipid rich plaque morphology that has been associated with stroke and cardiovascular disease (CVD). We sought to explore the contribution of the modifiable and not-modifiable cardiovascular risk factors (RFs) to vulnerable plaque morphology measured by the low GSM index. A total of 1,030 stroke-free community dwelling individuals with carotid plaques present (mean age, 71.8 ± 9.1; 58% women; 56% Hispanic, 20% Non-Hispanic Black, 22% Non-Hispanic White) were assessed for minimum GSM (min GSM) using high-resolution B-mode carotid ultrasound. Multiple linear regression models were used to evaluate the association between RFs and minGSM after adjusting for sociodemographic characteristics. Within an individual, median plaque number was 2 (IQR: 1–3) and mean plaque number 2.3 (SD: 1.4). Mean minGSM was 78.4 ± 28.7 (IQR: 56–96), 76.3 ± 28.8 in men and 80 ± 28.5 in women; 78.7 ± 29.3 in Hispanics participants, 78.5 ± 27.2 in Non-Hispanic Black participants, and 78.2 ± 29 in Non-Hispanic white participants. In multivariable adjusted model, male sex (β = −5.78, p = 0.007), obesity BMI (β = −6.92, p = 0.01), and greater levels of fasting glucose (β = −8.02, p = 0.02) and LDL dyslipidemia (β = −6.64, p = 0.005) were positively associated with lower minGSM, while presence of glucose lowering medication resulted in a significant inverse association (β = 7.68, p = 0.04). Interaction (with p for interaction <0.1) and stratification analyses showed that effect of age on minGSM was stronger in men (β = −0.44, p = 0.03) than in women (β = −0.20, p = 0.18), and in individuals not taking glucose lowering medication (β = −0.33, p = 0.009). Our study has demonstrated an important contribution of glycemic and lipid metabolism to vulnerable, low density or echolucent plaque morphology, especially among men and suggested that use of glucose lowering medication was associated with more fibrose-stable plaque phenotype (greater GSM). Further research is needed to evaluate effects of medical therapies in individuals with vulnerable, low density, non-stenotic carotid plaques and how these effects translate to prevention of cerebrovascular disease.
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Della‐Morte et al. (2022) conducted a cross-sectional in Carotid plaque (n=1,030). Vascular risk factors (glycemic and lipid parameters) vs. Individuals without the respective risk factors was evaluated on Minimum Gray-Scale Median (minGSM) index (β = -8.02, p=0.02). Male sex, obesity, higher fasting glucose, and LDL dyslipidemia were associated with lower carotid plaque Gray-Scale Median, whereas glucose-lowering medication was associated with higher GSM.
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