Atherosclerotic Carotid Plaque Composition and Incident Stroke and Coronary Events
Atherosclerotic Carotid Plaque Composition and Incident Stroke and Coronary Events
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DOI：
10.1016/j.jacc.2021.01.038
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发表时间：
2021-03-15
影响因子：
24
通讯作者：
van der Lugt, Aad
中科院分区：
文献类型：
--
作者：
Bos, Daniel;Arshi, Banafsheh;van der Lugt, Aad
背景越来越多的证据表明，动脉粥样硬化斑块组成而不是斑块大小与缺血性心血管事件有关，但无症状个体的大规模人群数据仍然很少。来自基于人群的鹿特丹研究的349例患者（平均年龄72岁，49.5%为女性），无卒中或CHD病史，颈动脉超声检查显示亚临床动脉粥样硬化，并接受颈动脉高分辨率磁共振成像以评估斑块特征。这些包括特定斑块成分的存在（斑块内出血[IPH]，富含脂质的坏死核心和钙化），以及斑块大小的测量（最大斑块厚度和超过30%的狭窄）。持续随访个体卒中或CHD的发生，直至2015年1月1日。作者使用考克斯回归模型来评估斑块特征与中风和冠心病发病率的相关性，并对年龄、性别和心血管危险因素进行了调整。独立于最大斑块厚度和心血管危险因素，IPH的存在与卒中和CHD事件相关（完全校正的风险比：2.42 [95%置信区间：1.30 - 4.50]和1.95 [95%置信区间：1.20 - 3.14]）。富含脂质的坏死核心和钙化的存在与卒中或CHD无关。结论颈动脉粥样硬化斑块中IPH的存在是卒中和CHD的独立危险因素。这些发现表明IPH有望作为亚临床动脉粥样硬化健康人群斑块易损性的标志物。（J Am科尔Cardiol 2021;77：1426-35）（c）2021作者。由爱思唯尔代表美国心脏病学会基金会出版。这是一个在CC BY-NC-ND许可证下的开放获取文章（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
BACKGROUND Increasing evidence suggests that atherosclerotic plaque composition rather than plaque size is linked to ischemic cardiovascular events, yet largescale population-based data in asymptomatic individuals remain scarce.OBJECTIVES This study sought to investigate carotid plaque composition in relation to incident stroke and coronary heart disease (CHD) in a population-based setting.METHODS Between 2007 and 2012, 1,349 persons (mean age 72 years, 49.5% women) from the population-based Rotterdam Study who were free from a history of stroke or CHD, in whom carotid ultrasonography showed subclinical atherosclerosis, and who underwent high-resolution magnetic resonance imaging of the carotid arteries to assess plaque characteristics. These included the presence of specific plaque components (intraplaque hemorrhage [IPH], lipid-rich necrotic core, and calcification), and measures of plaque size (maximum plaque thickness and presence of stenosis of more than 30%). Individuals were continuously followed for the occurrence of stroke or CHD until January 1, 2015. The authors used Cox regression models to assess the association of the plaque characteristics with the incidence of stroke and CHD, with adjustments for age, sex, and cardiovascular risk factors.RESULTS During a median of 5.1 years' follow-up for stroke and 4.8 years for CHD, 51 individuals had a stroke and 83 developed CHD. Independent of maximum plaque thickness and cardiovascular risk factors, the presence of IPH was associated with incident stroke and CHD (fully adjusted hazard ratio: 2.42 [95% confidence interval: 1.30 to 4.50], and 1.95 [95% confidence interval: 1.20 to 3.14]). Presence of a lipid-rich necrotic core and calcification were not associated with stroke or CHD.CONCLUSIONS The presence of IPH in the carotid atherosclerotic plaque is an independent risk factor for stroke and CHD. These findings indicate the promise of IPH as a marker of plaque vulnerability in healthy persons with subclinical atherosclerosis. (J Am Coll Cardiol 2021;77:1426-35) (c) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).