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Original article

Vol. 154 No. 1 (2024)

Prognostic impact of carotid plaque imaging using total plaque area added to SCORE2 in middle-aged subjects: the ARteris Cardiovascular Outcome (ARCO) cohort study

  • Michel Romanens
  • Ansgar Adams
  • Michel Wenger
  • Walter Warmuth
  • Isabella Sudano
DOI
https://doi.org/10.57187/s.3735
Cite this as:
Swiss Med Wkly. 2024;154:3735
Published
25.01.2024

Summary

AIMS: Many cardiovascular events occur in seemingly healthy individuals.We set out to assess the predictive value of atherosclerosis imaging in combination with cardiovascular risk calculators in subjects aged 40–65 years.

METHODS: We compared PROCAM (PROspective CArdiovascular Münster study), SCORE (Systematic COronary Risk Evaluation) and SCORE2 with carotid ultrasound (total plaque area, TPA) in subjects without cardiovascular disease. In this prospective cohort study, follow-up was obtained by phone or mail from patients; or from clinical records, if needed.

RESULTS: In 2842 subjects (mean age 50±8 years; 38% women), cardiovascular events occurred in 154 (5.4%) of them over an mean follow-up period of 5.9 (range 1–12) years, specifically: 41 cases of AMI (myocardial infarction), 16 strokes, 21 CABG (coronary artery bypass grafting), 41 PTCA (percutaneous transluminal coronary angioplasty) and 35 CAD (coronary artery disease). Mean PROCAM risk was 5±6%, mean SCORE risk was 1.3±1.6% and mean SCORE2 risk was 5±3%. Both for the primary outcome (major adverse cardiovascular events, MACEs, i.e. AMI + strokes) and the secondary outcome (atherosclerotic cardiovascular disease, ASCVD, i.e. MACEs + CABG + CAD + PTCA), hazards increased significantly for TPA tertiles and SCORE2 post-test risk between 6.7 to 12.8 after adjustment for risk factors (age, smoke, sex, systolic blood pressure, lipids, medication) and after adjustment for results from PROCAM, SCORE and SCORE2. Model performance was statistically improved regarding model fit in all models using TPA. Net reclassification improvement for SCORE2 with TPA post-test risk increased significantly by 24% for MACEs (p = 0.01) and 39% for ASCVD (p <0.0001).

CONCLUSIONS: Integration of TPA post-test risk into SCORE2 adds prognostic information, supporting the use of carotid ultrasound when assessing ASCVD risk in subjects aged 40–65 years.

References

  1. Collaboration S working group and EC risk, Achenbach S, Aleksandrova K, Amiano P, Sebastian D-S, Amouyel P, et al. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J. Oxford University Press (OUP); 2021;42(25):2439–54.
  2. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al.; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan;41(1):111–88. 10.1093/eurheartj/ehz455
  3. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al.; SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003 Jun;24(11):987–1003. 10.1016/S0195-668X(03)00114-3 DOI: https://doi.org/10.1016/S0195-668X(03)00114-3
  4. Romanens M, Adams A, Sudano I, Bojara W, Balint S, Warmuth W, et al. Prediction of cardiovascular events with traditional risk equations and total plaque area of carotid atherosclerosis: The Arteris Cardiovascular Outcome (ARCO) cohort study. Prev Med. 2021 Jun;147:106525. 10.1016/j.ypmed.2021.106525 DOI: https://doi.org/10.1016/j.ypmed.2021.106525
  5. Assmann G, Schulte H, Seedorf U. Cardiovascular risk assessment in the metabolic syndrome: results from the Prospective Cardiovascular Munster (PROCAM) Study. Int J Obes (Lond). 2008 May;32(S2 Suppl 2):S11–6. 10.1038/ijo.2008.29 DOI: https://doi.org/10.1038/ijo.2008.29
  6. Cordicare II Ethikkomissions Beschluss 122005S.
  7. Romanens M, Mortensen MB, Sudano I, Szucs T, Adams A. Extensive carotid atherosclerosis and the diagnostic accuracy of coronary risk calculators. Prev Med Rep. 2017 Mar;6:182–6. 10.1016/j.pmedr.2017.03.006 DOI: https://doi.org/10.1016/j.pmedr.2017.03.006
  8. Azarpazhooh MR, Mathiesen E, Rundek T, Romanens M, Adams A, Armando L, et al. Reliability, reproducibility and advantages of measuring carotid total plaque area. J Am Soc Echocardiogr. 2022 May;35(5):530–2. 10.1016/j.echo.2021.12.016 DOI: https://doi.org/10.1016/j.echo.2021.12.016
  9. Voss R, Cullen P, Schulte H, Assmann G. Prediction of risk of coronary events in middle-aged men in the Prospective Cardiovascular Münster Study (PROCAM) using neural networks. Int J Epidemiol. 2002 Dec;31(6):1253–62. 10.1093/ije/31.6.1253 DOI: https://doi.org/10.1093/ije/31.6.1253
  10. Romanens M, Ackermann F, Spence JD, Darioli R, Rodondi N, Corti R, et al. Improvement of cardiovascular risk prediction: time to review current knowledge, debates, and fundamentals on how to assess test characteristics. Eur J Cardiovasc Prev Rehabil. 2010 Feb;17(1):18–23. 10.1097/HJR.0b013e3283347059 DOI: https://doi.org/10.1097/HJR.0b013e3283347059
  11. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988 Sep;44(3):837–45. 10.2307/2531595 DOI: https://doi.org/10.2307/2531595
  12. Melander O, Newton-Cheh C, Almgren P, Hedblad B, Berglund G, Engström G, et al. Novel and conventional biomarkers for prediction of incident cardiovascular events in the community. JAMA. 2009 Jul;302(1):49–57. 10.1001/jama.2009.943 DOI: https://doi.org/10.1001/jama.2009.943
  13. Romanens M, Adams A, Bojara W, Balint S, Warmuth W. Cost-effectiveness analysis of statins in primary care: results from the Arteris cohort study. Swiss Med Wkly. 2021 Apr;151(1516):w20498. 10.4414/smw.2021.20498 DOI: https://doi.org/10.4414/smw.2021.20498
  14. Visseren F. Mach Francois, Smulders Yvo, Carballo David, Koskina Konstantinos et al. 2021 ESC Guidelines on cardiovascular diseaseprevention in clinical practice. Konstantinos P Tsioufis [Internet]. Bryan Williams; [cited 2022 Nov 26];5. Available from: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab484/6358713
  15. Johri AM, Nambi V, Naqvi TZ, Feinstein SB, Park MM, Becher H, et al. Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography (in press). J Am Soc Echocardiogr. 2020;27713(8):1–17. 10.1016/j.echo.2020.04.021 DOI: https://doi.org/10.1016/j.echo.2020.04.021
  16. Raggi Paolo, Stein James H. Carotid intima-media thickness should not be referred to as subclinical atherosclerosis: A recommended update to the editorial policy at Atherosclerosis. Atherosclerosis. Elsevier BV; 2020 Sep; DOI: https://doi.org/10.1016/j.atherosclerosis.2020.09.015
  17. Romanens M, Sudano I, Adams A, Schober EA. Sonographic assessment of carotid atherosclerosis: preferred risk indicator for future cardiovascular events? Swiss Med Wkly. 2019 Dec;149:w20142. 10.4414/smw.2019.20142 DOI: https://doi.org/10.4414/smw.2019.20142
  18. Fernández-Friera L, Peñalvo JL, Fernández-Ortiz A, Ibañez B, López-Melgar B, Laclaustra M, et al. Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort: The PESA (Progression of Early Subclinical Atherosclerosis) Study. Circulation. 2015 Jun;131(24):2104–13. 10.1161/CIRCULATIONAHA.114.014310 DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.014310
  19. Philips MS. VL13-5 transducer with specifications. [Internet]. Available from: https://www.usa.philips.com/healthcare/product/HC989605409591/vl13-5-broadband-linear-volume-array-transducer
  20. Spence JD, Eliasziw M, DiCicco M, Hackam DG, Galil R, Lohmann T. Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. Stroke. 2002 Dec;33(12):2916–22. 10.1161/01.STR.0000042207.16156.B9 DOI: https://doi.org/10.1161/01.STR.0000042207.16156.B9
  21. Prati P, Tosetto A, Vanuzzo D, Bader G, Casaroli M, Canciani L, et al. Carotid intima media thickness and plaques can predict the occurrence of ischemic cerebrovascular events. Stroke. 2008 Sep;39(9):2470–6. 10.1161/STROKEAHA.107.511584 DOI: https://doi.org/10.1161/STROKEAHA.107.511584
  22. David Spence J. The importance of distinguishing between diffuse carotid intima-media thickening and focal plaque. Can J Cardiol. 2008;24:61C–4C. 10.1016/S0828-282X(08)71041-9 DOI: https://doi.org/10.1016/S0828-282X(08)71041-9
  23. Schmermund A, Achenbach S, Budde T, Buziashvili Y, Förster A, Friedrich G, et al. Effect of intensive versus standard lipid-lowering treatment with atorvastatin on the progression of calcified coronary atherosclerosis over 12 months: a multicenter, randomized, double-blind trial. Circulation. 2006 Jan;113(3):427–37. 10.1161/CIRCULATIONAHA.105.568147 DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.568147
  24. Adams A, Bojara W, Romanens M. Effect of Statin Treatment in Patients With Advanced Carotid Atherosclerosis: An Observational Outcome Study. Cardiol Res. 2021 Dec;12(6):335–9. 10.14740/cr1318 DOI: https://doi.org/10.14740/cr1318
  25. Spence JD, Hackam DG, Spence D, Hackam DG, Spence JD, Hackam DG. Treating arteries instead of risk factors: a paradigm change in management of atherosclerosis. Stroke. 2010 Jun;41(6):1193–9. 10.1161/STROKEAHA.110.577973 DOI: https://doi.org/10.1161/STROKEAHA.110.577973
  26. Herder M, Arntzen KA, Johnsen SH, Eggen AE, Mathiesen EB. Long-term use of lipid-lowering drugs slows progression of carotid atherosclerosis: the Tromso study 1994 to 2008. Arterioscler Thromb Vasc Biol. 2013 Apr;33(4):858–62. 10.1161/ATVBAHA.112.300767 DOI: https://doi.org/10.1161/ATVBAHA.112.300767
  27. Sturlaugsdottir R, Aspelund T, Bjornsdottir G, Sigurdsson S, Thorsson B, Eiriksdottir G, et al. Predictors of carotid plaque progression over a 4-year follow-up in the Reykjavik REFINE-study. Atherosclerosis. 2018 Feb;269:57–62. 10.1016/j.atherosclerosis.2017.12.005 DOI: https://doi.org/10.1016/j.atherosclerosis.2017.12.005
  28. Belcaro G, Nicolaides AN, Ramaswami G, Cesarone MR, De Sanctis M, Incandela L, et al. Carotid and femoral ultrasound morphology screening and cardiovascular events in low risk subjects: a 10-year follow-up study (the CAFES-CAVE study(1)). Atherosclerosis. 2001 Jun;156(2):379–87. 10.1016/S0021-9150(00)00665-1 DOI: https://doi.org/10.1016/S0021-9150(00)00665-1
  29. Baber U, Mehran R, Sartori S, Schoos M, Falk E, Sillesen H, et al. Detection and Impact of Subclinical Coronary and Carotid Atherosclerosis on Cardiovascular Risk Prediction and Reclassification in Asymptomatic Us Adults: Insights From the High Risk Plaque Bioimage Study. J Am Coll Cardiol. 2014;63(12):A998. 10.1016/S0735-1097(14)60998-0 DOI: https://doi.org/10.1016/S0735-1097(14)60998-0
  30. Brunner FJ, Waldeyer C, Ojeda F, Salomaa V, Kee F, Sans S, et al.; Multinational Cardiovascular Risk Consortium. Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium. Lancet. 2019 Dec;394(10215):2173–83. 10.1016/S0140-6736(19)32519-X DOI: https://doi.org/10.1016/S0140-6736(19)32519-X

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