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Sun X, Wu C, Kang J, Lv H, Liu X. Development and validation of a risk prediction model for short-term progression of carotid atherosclerosis among early middle age adults. Atherosclerosis 2024; 397:118557. [PMID: 39180959 DOI: 10.1016/j.atherosclerosis.2024.118557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/15/2024] [Accepted: 08/06/2024] [Indexed: 08/27/2024]
Abstract
AIM We aimed at creating and validating a prognostic model incorporating easily accessible clinical and laboratory parameters to forecast the likelihood of short-term progression of carotid atherosclerosis. METHODS A prediction model was developed and validated for carotid plaque progression within 2 years in an early middle-age population in China. Progression was defined as the new appearance of carotid plaque or stenosis among participants who had normal carotid status at baseline. Leveraging data from a health check-up chain, predictors were identified using statistical methods including stepwise logistic regression, Markov Chain Monte Carlo (MCMC) simulation, random forest analysis and least absolute shrinkage selection operator (Lasso). Model performance was assessed. Bootstrap internal validation, validation on another check-up population and subgroup analysis were also conducted. RESULTS Among 7765 participants, predictors including age, diastolic blood pressure, uric acid levels, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were identified for carotid plaque progression in 2 years. The developed prediction model demonstrated good discrimination (AUC = 0.755, 95%CI:0.736-0.774) and calibration ability (slope = 0.922 and interception = 0.007) among development data, as well as among validation data (AUC = 0.759, 95%CI:0.674-0.770; slope = 1.076 and intercept = -0.014). Internal validation using bootstrap method yielded an adjusted AUC of 0.753. The model's performance remained consistent across different subgroups. CONCLUSIONS Our study presents a validated risk prediction model for carotid plaque progression in an early middle age population, offering a valuable tool for early identification and monitoring of cardiovascular risks. The model's robustness and applicability across different subgroups highlight its potential utility in preemptive cerebrovascular and cardiovascular disease management.
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Affiliation(s)
- Xinghe Sun
- Department of Cardiology, Peking University International Hospital, Beijing, People's Republic of China.
| | - Chaoqun Wu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Junping Kang
- Department of Cardiology, Peking University International Hospital, Beijing, People's Republic of China
| | - Hui Lv
- Healthcare Management Center, Peking University International Hospital, Beijing, People's Republic of China
| | - Xiaohui Liu
- Department of Cardiology, Peking University International Hospital, Beijing, People's Republic of China.
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2
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Qin L, Wu X, Tan C, Zhang Z, Li Y, Zhu X, Qin S, Tan S. Non-linear association and benchmark dose of blood pressure on carotid artery intima-media thickening in a general population of southern China. Front Cardiovasc Med 2024; 11:1325947. [PMID: 38803665 PMCID: PMC11128656 DOI: 10.3389/fcvm.2024.1325947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Background and aims This study aimed to evaluate whether there is a J-curve association between blood pressure (BP) and carotid artery intima-media thickening (CAIT) and estimate the effect of the turning point of BP on CAIT. Methods and results Data from 111,494 regular physical examinations conducted on workers and retirees (aged 18 years or older) between January 2011 and December 2016, exported from the hospital information system, were analyzed. Restricted cubic splines (RCS) logistic regression was employed to access the association of BP with CAIT, and Bayesian benchmark dose methods were used to estimate the benchmark dose as the departure point of BP measurements. All the pnon-linear values of BP measurements were less than 0.05 in the RCS logistic regression models. Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) had J-curve associations with the risk of CAIT at a turning point around 120/70 mmHg in the RCS. The benchmark dose for a 1% change in CAIT risk was estimated to be 120.64 mmHg for SBP and 72.46 mmHg for DBP. Conclusion The J-curve associations between SBP and DBP and the risk of CAIT were observed in the general population in southern China, and the turning point of blood pressure for significantly reducing the risk of CAIT was estimated to be 120.64/72.46 mmHg for SBP/DBP.
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Affiliation(s)
- Linyuan Qin
- Department of Epidemiology and Health Statistics, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
| | - Xiaoyan Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
| | - Chao Tan
- Department of Epidemiology and Health Statistics, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
| | - Zhengbao Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
| | - You Li
- Department of Epidemiology and Health Statistics, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
| | - Xiaonian Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
| | - Shenghua Qin
- Physical Examination Center, Guilin People's Hospital, Guilin, Guangxi, China
| | - Shengkui Tan
- Department of Epidemiology and Health Statistics, School of Public Health, Guilin Medical University, Guilin, Guangxi, China
- Guangxi Key Laboratory of Environmental Exposomics and Entire Lifecycle Health, Guilin Medical University, Guilin, Guangxi, China
- Party Committee Office, Youjiang Medical University for Nationalities, Baise, Guangxi, China
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3
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Yu Z, Yang H, Shou B, Cheng Z, Jiang C, Xu J. Association between pulse pressure and carotid plaques in old adults with uncontrolled hypertension: results from a community-based screening in Hangzhou, China. BMC Cardiovasc Disord 2024; 24:249. [PMID: 38734608 PMCID: PMC11088081 DOI: 10.1186/s12872-024-03914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND There is a broad pulse pressure (PP) and a high prevalence of carotid plaques in old adults. Previous studies have indicated that PP is strongly associated with carotid plaque formation. This study aimed to explore this association in old adults with uncontrolled hypertension. METHODS 1371 hypertensive patients aged ≥ 60 years with uncontrolled hypertension were enrolled in a community-based screening in Hangzhou, China. Carotid plaques were assessed using ultrasonography. Logistic regression models were used to estimate the association between PP and carotid plaques by odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Carotid plaques were detected in 639 (46.6%) of subjects. Multiple plaques were found in 408 (63.8%) and soft plaques in 218 (34.1%). Elevated PP was associated with a high prevalence of carotid plaques. After adjusting for traditional risk factors, compared to patients within the lowest tertile of PP, those within the highest tertiles had an increased risk of carotid plaques (OR 2.061, CI 1.547-2.745). For each 1-SD increase, the risk increased by 40.1% (OR 1.401, CI 1.237-1.587). There was a nonlinear association between PP and carotid plaques (P nonlinearity = 0.039). The risk increased rapidly after the predicted PP level reached around 60 mmHg. The associations were stronger among participants with multiple and soft plaques. CONCLUSIONS Our findings suggested that PP was independently associated with carotid plaques in old adults with uncontrolled hypertension who have an increased risk of atherosclerosis.
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Affiliation(s)
- Zhecong Yu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China
| | - Haifeng Yang
- Fuyang Center for Disease Control and Prevention, Hangzhou, 311400, P. R. China
| | - Biqi Shou
- Fuyang Center for Disease Control and Prevention, Hangzhou, 311400, P. R. China
| | - Zongxue Cheng
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China
| | - Caixia Jiang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China
| | - Jue Xu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China.
- Institute for Chronic Noncommunicable Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, 310000, P. R. China.
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4
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Lyngbakken MN, Kvisvik B, Berge T, Pervez MO, Aagaard EN, Ariansen I, Omland T, Tveit A, Steine K, Røsjø H. Serial blood pressure measurements, left ventricular remodelling and cardiovascular outcomes. Eur J Clin Invest 2023; 53:e13876. [PMID: 36120822 PMCID: PMC10078318 DOI: 10.1111/eci.13876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hypertension is a risk factor for the development of cardiovascular disease. Whether serial blood pressure (BP) measurements are more closely associated with subclinical left ventricular (LV) remodelling and better predict risk of cardiovascular events over individual BP measurements are not known. METHODS We assessed systolic BP, diastolic BP and pulse pressure at several time points during adulthood in 1333 women and 1211 men participating in the Akershus Cardiac Examination 1950 Study. We defined serial BP measurements as the sum of averaged BPs from adjacent consecutive visits indexed to total exposure time between measurements. We assessed the associations between serial and individual BP measurements and (1) LV structure, function and volumes and (2) incident myocardial infarction, ischemic stroke, heart failure and cardiovascular death. RESULTS All indices of higher serial BP measurements were associated with increased indexed LV mass, and the associations were stronger than those of individual BP measurements. Serial diastolic BP pressure was strongly and inversely associated with LV systolic function, while higher serial systolic BP was primarily associated with higher LV volumes. Both serial systolic (incidence rate ratio [IRR] 1.10, 95% CI 1.03 to 1.17) and diastolic BPs (IRR 1.14, 95% CI 1.02 to 1.27) were associated with increased incidence of clinical events. CONCLUSION In healthy community dwellers without established cardiovascular disease, different serial BP indices associate strongly with LV remodelling and cardiovascular outcomes. Whether the use of serial BP indices for guiding treatment is superior to individual measurements should be explored in additional prospective studies.
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Affiliation(s)
- Magnus Nakrem Lyngbakken
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Brede Kvisvik
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Berge
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Mohammad Osman Pervez
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Erika Nerdrum Aagaard
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Research, Baerum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
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Lin Y, Li Y, Li Z, Zhang Z, Liu J, Sun J, Tu J, Wang J, Zhang W, Li J, Ning X. Sex-Related Differences in the Incidence and Development of Carotid Plaques in a Low-Income Chinese Population-A Prospective Cohort Study. Int J Womens Health 2022; 14:787-795. [PMID: 35733846 PMCID: PMC9208630 DOI: 10.2147/ijwh.s365242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose More than 150 million people are estimated to have been examined for the presence of carotid plaques (CPs) in China; a sex-related imbalance in the prevalence exists. However, the relationship between sex and the incidence of CP development is unclear, especially in low-income areas of China. Hence, this study aimed to identify the sex differences in CP development and CP burden in both sexes in this population. Methods The study population included individuals aged ≥45 years in a rural area of Tianjin, China. Carotid ultrasonography was performed in the 2014 and 2019 cohorts, and information on carotid ultrasonography, including the formation and number of CPs, was collected twice. Logistic analyses were used to investigate the predictors of CP formation and numbers of plaques. Results A total of 1479 participants were analyzed. The incidence of CP was 20.3% and 29.0% in women and men, respectively. In women, high low-density lipoprotein cholesterol (LDL-C) levels was independent predictors of CP formation (RR: 1.217, 95%CI: 1.010, 1.461; P=0.039). For men, the corresponding predictors were hypertension, alcohol consumption, and low high-density lipoprotein cholesterol (HDL-C) levels (all P<0.05); none of the examined factors were associated with plaque numbers. Conclusion In the study population, men had a higher incidence of plaque than women. Predictors of CP are different in men and women. LDL-C control is critical for moderating atherosclerosis in women; in men, managing blood pressure, stopping alcohol consumption, and controlling HDL-C levels are important.
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Affiliation(s)
- Yunpeng Lin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Yan Li
- Department of Anesthesiology, Tianjin Jizhou People's Hospital, Tianjin, 301900, People's Republic of China.,Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, 301900, People's Republic of China
| | - Zhiying Li
- Department of Acupuncture, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine & National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, People's Republic of China
| | - Zhen Zhang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Jie Liu
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, 301900, People's Republic of China.,Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People's Republic of China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People's Republic of China
| | - Jiayi Sun
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Jun Tu
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, 301900, People's Republic of China.,Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People's Republic of China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People's Republic of China
| | - Jinghua Wang
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, 301900, People's Republic of China.,Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People's Republic of China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People's Republic of China
| | - Wenjuan Zhang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Jidong Li
- Department of Anesthesiology, Tianjin Jizhou People's Hospital, Tianjin, 301900, People's Republic of China.,Department of Neurosurgery, Tianjin Jizhou People's Hospital, Tianjin, 301900, People's Republic of China
| | - Xianjia Ning
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, 301900, People's Republic of China.,Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People's Republic of China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People's Republic of China
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6
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Lin Q, Liu J, Hu P, Li T, Yang Q, Tu J, Wang J, Li J, Ning X. Incidence and predictors of progression of carotid atherosclerosis in a low-income Chinese population-a prospective cohort study. Postgrad Med 2021; 134:85-95. [PMID: 34696679 DOI: 10.1080/00325481.2021.1997483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE More than 200 million individuals have been diagnosed with carotid atherosclerosis (CAS) in China. We aimed to investigate the incidence and potential predictors of CAS progression in a low-income rural area in China. METHODS A population-based cohort study was conducted on individuals aged ≥45 years from 2014 to 2019. Multivariable analyses were used to investigate the predictors of carotid plaque (CP) formation, plaque number, and carotid intima-media thickness (CIMT). RESULTS A total of 1479 participants were finally enrolled in this study. The incidence rate of CP was 42.9 cases per 1000 person-years, and the progression of median CIMT was 137.50 μm over five years. The risk of CP formation increased 2-fold in participants aged ≥75 years (P = 0.002) compared with those aged 45-54 years. The corresponding risk was 59% higher in participants with hypertension (P = 0.001) and 73% higher in alcohol drinkers (P = 0.006). With each 1- standard deviations (SD) increase in high- and low-density lipoprotein cholesterol levels, the risk of CP occurrence decreased by 16% (P = 0.016) and increased by 29% (P = 0.002), respectively. Participants aged ≥75 years exhibited a 3.3-fold higher risk of having a high number of plaques than those aged 45-54 years (P = 0.014). Moreover, older age and the waist-to-hip ratio were independent predictors of CIMT progression. CONCLUSIONS This is the first longitudinal study to explore the incidence and predictors of CAS progression in a low-income rural population in China with a high prevalence of stroke. More detailed and precise strategies for prevention and intervention of CAS progression are necessary, especially in low-income rural areas in China.
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Affiliation(s)
- Qiuxing Lin
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, China
| | - Peng Hu
- Department of Neurology, Binhai New Area Hospital of TCM, Tianjin, China
| | - Teng Li
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiaoxia Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, China
| | - Jidong Li
- Department of Neurosurgery, Tianjin Jizhou People's Hospital, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education and Tianjin City, Tianjin, China.,Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People's Hospital, Tianjin, China
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7
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Li H, Xu X, Luo B, Zhang Y. The Predictive Value of Carotid Ultrasonography With Cardiovascular Risk Factors-A "SPIDER" Promoting Atherosclerosis. Front Cardiovasc Med 2021; 8:706490. [PMID: 34447790 PMCID: PMC8382941 DOI: 10.3389/fcvm.2021.706490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022] Open
Abstract
Insufficient recommendations do not support the clinical use of carotid ultrasonography for further risk stratification in moderate-to-high risk patients with cardiovascular disease (CVD). A literature review was performed to assess six aspects of the research progress and limitations of carotid ultrasonography and carotid atherosclerosis-related risk factors: (1) structures of the carotid intima and media; (2) plaques; (3) inflammation; (4) dynamics of carotid blood flow; (5) early detection and intervention; and (6) risk factors for CVD. Although carotid intima-media thickness and carotid plaques are well-acknowledged independent predictors of CVD risk, normative and cut-off values are difficult to define due to the heterogeneous measurements reported in previous studies. Plaque properties, including location, number, density, and size, become more important risk predictors for cardiovascular disease, but a better approach for clinical use needs to be further established. Three-dimensional ultrasound and contrast-enhanced ultrasound are promising for promoting risk stratification with more details on plaque morphology. Moreover, inflammatory diseases and biomarkers should be evaluated for a full assessment of the inflammatory burden for atherosclerosis. Carotid flow velocity is not only an indicator for stenosis but also a potential risk predictor. Carotid atherosclerosis should be detected and treated early, and additional clinical trials are needed to determine the efficacy of these measures in reducing CVD risk. Cardiovascular risk factors tend to affect carotid plaques, and early treat-to-target therapy might yield clinical benefits. Based on the aforementioned six aspects, we consider that these six important factors act like a “SPIDER” spinning the web of atherosclerosis; a timely comprehensive assessment and intervention may halt the progression to CVD. Carotid ultrasound results should be combined with other atherosclerotic factors, and a comprehensive risk assessment may help to guide cardiovascular prevention decisions.
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Affiliation(s)
- Hongwei Li
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
| | - Xiaolin Xu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuling Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, China
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