Carotid plaque area: A tool for targeting and evaluating vascular preventive therapy

• Published in: Stroke (1970) Vol. 33; no. 12; pp. 2916 - 2922
• Main Authors: SPENCE, J. David, ELIASZIW, Michael, DICICCO, Maria, HACKAM, Daniel G, GALIL, Ramzy, LOHMANN, Tara
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-12-2002; American Heart Association, Inc
• Subjects: Adult; Age Factors; Aged; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Arteries - diagnostic imaging; Carotid Artery Diseases - classification; Carotid Artery Diseases - diagnostic imaging; Disease Progression; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - prevention & control; Predictive Value of Tests; Remission, Spontaneous; Risk; Risk Assessment; Risk Factors; Stroke - prevention & control; Ultrasonography; Sonography; Human; Nervous system diseases; Stroke; Infarct; ultrasonography; Cardiovascular disease; Coronary heart disease; Myocardial disease; Cerebral disorder; Vascular disease; Atherosclerotic plaque; Carotid; Central nervous system disease; Atherosclerosis; Echography; Risk factor; Myocardium; Evolution; risk; cerebrovascular disorders; Cerebrovascular disease; stroke prevention
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000042207.16156.B9

Carotid plaque area measured by ultrasound (cross-sectional area of longitudinal views of all plaques seen) was studied as a way of identifying patients at increased risk of stroke, myocardial infarction, and vascular death.
Patients from an atherosclerosis prevention clinic were followed up annually for up to 5 years (mean, 2.5+/-1.3 years) with baseline and follow-up measurements recorded. Plaque area progression (or regression) was defined as an increase (or decrease) of >/=0.05 cm(2) from baseline.
Carotid plaque areas from 1686 patients were categorized into 4 quartile ranges: 0.00 to 0.11 cm(2) (n=422), 0.12 to 0.45 cm(2) (n=424), 0.46 to 1.18 cm(2) (n=421), and 1.19 to 6.73 cm(2) (n=419). The combined 5-year risk of stroke, myocardial infarction, and vascular death increased by quartile of plaque area: 5.6%, 10.7%, 13.9%, and 19.5%, respectively (P<0.001) after adjustment for all baseline patient characteristics. A total of 1085 patients had >/=1 annual carotid plaque area measurements: 685 (63.1%) had carotid plaque progression, 306 (28.2%) had plaque regression, and 176 (16.2%) had no change in carotid plaque area over the period of follow-up. The 5-year adjusted risk of combined outcome was 9.4%, 7.6%, and 15.7% for patients with carotid plaque area regression, no change, and progression, respectively (P=0.003).
Carotid plaque area and progression of plaque identified high-risk patients. Plaque measurement may be useful for targeting preventive therapy and evaluating new treatments and response to therapy and may improve cost-effectiveness of secondary preventive treatment.