Is carotid artery evaluation necessary for primary prevention in asymptomatic high-risk patients without atherosclerotic cardiovascular disease?

Figures & data

Figure 1 Flowchart of study population.

Abbreviations: ASCVD, atherosclerotic cardiovascular disease; CAG, coronary angiography.

Table 1 Baseline characteristics of 873 participants without ASCVD according to atherosclerotic cardiovascular events

	No event (n=754)	Events (n=119)	P-value
Age, yrs	59±12	63±10	<0.0001
Male, n (%)	416 (55.2)	71 (59.7)	0.373
Body mass index, kg/m^2	25.3±3.2	24.8±2.9	0.089
Fasting plasma glucose, mg/dL	116±34	125±38	0.008
Hemoglobin A1c, %	6.1±1.3	6.4±1.4	0.086
Total cholesterol, mg/dL	188±37	190±49	0.637
Triglyceride, mg/dL	142±90	141±103	0.950
High-density lipoprotein cholesterol, mg/dL	46±11	43±11	0.005
Low-density lipoprotein cholesterol, mg/dL	116±32	118±38	0.464
hs-CRP, mg/dL	5.8±19.8	6.8±11.3	0.585
Systolic blood pressure, mmHg	121±16	121±19	0.893
Diastolic blood pressure, mmHg	74±11	72±11	0.047
Left ventricle ejection fraction, %	62±6	61±6	0.242
Smoking, n (%)	170 (24.3)	39 (33.1)	0.052
Diabetes mellitus, n (%)	171 (22.7)	36 (30.3)	0.082
Hypertension, n (%)	377 (50.0)	77 (64.7)	0.003
Atrial fibrilation, n (%)	14 (1.9)	2 (1.7)	0.624
Medication
Aspirin, n (%)	85 (15.1)	13 (14.1)	0.480
ACE inhibitor or ARB, n (%)	349 (49.9)	87 (75.7)	<0.0001
Beta-blocker, n (%)	248 (35.5)	62 (53.9)	<0.0001
Calcium channel blocker, n (%)	192 (27.5)	23 (20.0)	0.110

Abbreviations: yrs, years; ASCVD, atherosclerotic cardiovascular disease; hs-CRP, high-sensitivity C-reactive protein; ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker.

Table 2 Carotid artery measurements of the 873 study participants

	No event (n=754)	Events (n=119)	P-value
Intima–media thickness
Maximum CCA thickness, mm	0.954±0.249	1.025±0.362	0.003
Mean CCA thickness, mm	0.807±0.192	0.851±0.230	0.027
Plaque, n (%)	255 (33.8)	61 (51.3)	<0.0001

Abbreviation: CCA, common carotid artery.

Table 3 HRs for atherosclerotic cardiovascular events in participants without ASCVD

Variables	Univariate			Multivariate
	HR	95% CI	P-value	HR	95% CI	P-value
Age, yrs	1.029	1.012–1.046	0.001	1.026	1.002–1.050	0.033
Fasting plasma glucose, mg/dL	1.006	1.001–1.010	0.008	1.002	0.996–1.008	0.568
Hemoglobin A1c, %	1.151	1.016–1.303	0.027	0.996	0.820–1.208	0.965
High-density lipoprotein cholesterol, mg/dL	0.978	0.961–0.995	0.011	0.983	0.963–1.003	0.102
Diastolic blood pressure, mmHg	0.981	0.964–0.998	0.029	0.992	0.972–1.012	0.409
Smoking, n (%)	1.540	1.049–2.262	0.028	1.751	1.089–2.815	0.021
Hypertension, n (%)	1.764	1.211–2.570	0.003	0.686	0.440–1.071	0.097
Medication
Lipid-lowering agent, n (%)	0.296	0.177–0.495	<0.0001	0.388	0.205–0.734	0.004
ACE inhibitor or ARB, n (%)	0.353	0.230–0.540	<0.0001	0.743	0.457–1.209	0.231
Beta-blocker, n (%)	0.495	0.343–0.715	<0.0001	0.852	0.556–1.306	0.463
Intima–media thickness
Maximum CCA thickness, mm	2.243	1.309–3.843	0.003	1.659	0.488–5.641	0.417
Mean CCA thickness, mm	2.795	1.176–6.641	0.020	0.246	0.031–1.932	0.182
Plaque, n (%)	2.146	1.494–3.081	<0.0001	1.556	1.009–2.400	0.045

Abbreviations: HRs, hazard ratios; ASCVD, atherosclerotic cardiovascular disease; CI, confidence interval; yrs, years; ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; CCA, common carotid artery.

Table 4 HRs for atherosclerotic cardiovascular events in middle-aged individuals

Variables	Univariate			Multivariate
	HR	95% CI	P-value	HR	95% CI	P-value
Fasting plasma glucose, mg/dL	1.008	1.001–1.015	0.017	0.999	0.990–1.009	0.845
Hemoglobin A1c	1.284	1.063–1.550	0.009	1.189	0.918–1.541	0.189
Smoking, n	1.991	1.196–3.315	0.008	1.995	1.142–3.485	0.015
Hypertension, n	1.731	1.035–2.895	0.036	1.281	0.712–2.305	0.409
Medication
Lipid-lowering agent, n	0.248	0.118–0.522	<0.0001	0.320	0.131–0.780	0.012
ACE inhibitor or ARB, n	0.368	0.221–0.613	<0.0001	0.581	0.257–1.315	0.193
Beta-blocker, n	0.239	0.124–0.459	<0.0001	0.699	0.383–1.273	0.699
Plaque, n	2.656	1.599–4.411	<0.0001	1.993	1.116–3.560	0.020

Abbreviations: HRs, hazard ratios; CI, confidence interval; ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker.

Figure 2 Cumulative HRs for ASCVD events according to plaques (A) and maximum intima–media thickness (B) in middle-aged (black line) and elderly (dashed line) groups.

Abbreviations: HR, hazard ratio; ASCVD, atherosclerotic cardiovascular disease; CI, confidence interval; IMT, intima–media thickness.