Key result
CHD linked to ~2.6-fold higher odds of carotid plaque instability alongside smoking and diabetes.
Why the study?
The association between traditional cerebrovascular risk factor burden and ultrasound-based carotid plaque phenotyping needed investigation.
Does traditional cerebrovascular risk factor burden predict ultrasound-based carotid plaque instability, thickness, and cross-sectional area in patients with carotid plaques?
Cross-Sectional (n=486)
No
Does traditional cerebrovascular risk factor burden predict ultrasound-based carotid plaque instability, thickness, and cross-sectional area in patients with carotid plaques?
Cumulative traditional risk factors, coronary heart disease, stenosis severity, and a synergistic interaction between diabetes and hyperlipidemia are independently associated with ultrasound-assessed carotid plaque vulnerability and burden.
May aid vulnerable plaque identification on imaging; leaves open causal inference and clinical utility pending prospective data.
OBJECTIVE: To investigate the association between traditional cerebrovascular risk factor burden and ultrasound-based carotid plaque phenotyping. METHOD: This single-center cross-sectional study included 486 patients with carotid plaques detected by ultrasound. Multivariate logistic regression was used to identify factors independently associated with plaque instability, and multiple linear regression was used to examine determinants of plaque maximum thickness and cross-sectional area. RESULTS: Among 486 patients, 170 (35.0%) had unstable plaques. In the fully adjusted model, male sex (OR = 1.66, 95% CI: 1.06-2.61, p = 0.028), higher BMI (OR = 1.08, 95% CI: 1.01-1.16, p = 0.022), smoking (OR = 1.72, 95% CI: 1.11-2.70, p = 0.015), alcohol consumption (OR = 1.56, 95% CI: 1.01-2.44, p = 0.044), coronary heart disease (OR = 2.63, 95% CI: 1.56-4.48, p < 0.001), and stenosis severity (moderate: OR = 2.69, 95% CI: 1.64-4.42, p < 0.001; severe: OR = 6.89, 95% CI: 3.03-15.81, p < 0.001) were independently associated with plaque vulnerability. Adding clinical and imaging variables significantly improved model discrimination (AUC: 0.749 vs. 0.787; likelihood ratio test: p = 0.003). The diabetes-hyperlipidemia interaction term was significant (OR = 3.30, 95% CI: 1.24-8.79, p = 0.017), suggesting a synergistic effect. Fasting blood glucose (FBG), analyzed as a continuous variable, was independently associated with greater plaque thickness (β = 0.08, 95% CI: 0.01-0.15, p = 0.036) and cross-sectional area (β = 0.70, 95% CI: 0.25-1.16, p = 0.003). Restricted cubic spline analysis further revealed U-shaped dose-response relationships between both FBG and LDL-C with plaque cross-sectional area (P-nonlinear = 0.001 for both), with inflection points at approximately 6.6 and 3.0 mmol/L, respectively. CONCLUSION: Male sex, higher BMI, smoking, alcohol consumption, coronary heart disease, and stenosis severity were independently associated with carotid plaque instability. Diabetes and hyperlipidemia exhibited a significant synergistic effect. Diabetes was associated with increased plaque volume. These findings suggest that risk assessment should focus on cumulative risk burden rather than isolated indicators.
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李风娟 et al. (2026) conducted a cross-sectional in Carotid atherosclerotic plaques (n=486). Traditional cerebrovascular risk factor burden (e.g., coronary heart disease, smoking, BMI, diabetes-hyperlipidemia interaction) vs. Absence or lower burden of risk factors was evaluated on Carotid plaque instability/vulnerability (OR 2.63, 95% CI 1.56-4.48, p=<0.001). Cerebrovascular risk factors including CHD (OR 2.63), smoking (OR 1.72), and diabetes-hyperlipidemia interaction (OR 3.30) were independently associated with carotid plaque instability.
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