Change in Carotid Plaque Components: A 4-Year Follow-Up Study With Serial MR Imaging

^aDepartment of Epidemiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
^bDepartment of Radiology, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
^cThe Netherlands Institute of Health Sciences, Erasmus Medical Center University Medical Center, Rotterdam, the Netherlands
^dDepartment of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts

↵∗Address for correspondence:
Dr. Meike W. Vernooij, Departments of Epidemiology, Erasmus MC, University Medical Center, Office Secretariat Epidemiology: Room Na28-18, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.

Graphical abstract

Abstract

Objectives The goal of this study was to determine how carotid plaque components (e.g., intraplaque hemorrhage [IPH], calcification, lipid core) change over time and which cardiovascular risk factors are associated with the development of each component.

Background Carotid atherosclerotic plaque components are important markers of plaque vulnerability. How these components change and which factors lead to the development and changes in the components remain unclear.

Methods A total of 198 participants (mean age 67.5 ± 10.6 years) from the population-based Rotterdam Study, all with carotid wall thickening on ultrasound, underwent 2 magnetic resonance imaging scans for carotid plaque characterization (mean interscan interval 4.1 ± 0.2 years). Presence of IPH, calcification, and lipid-rich necrotic core was assessed on both sides on the baseline and follow-up scans. The association between cardiovascular risk factors and incident carotid plaque components was assessed.

Results In the 396 arteries, all plaque components significantly changed over time. Incidence of IPH, calcification, and lipid core was, respectively, 18.5%, 59.2%, and 39.6%. The factor most strongly associated with the incidence of IPH was use of antihypertensive drugs (multivariate adjusted odds ratio [OR]: 3.87; 95% confidence interval [CI]: 1.90 to 7.90) and severe hypertension (multivariate adjusted OR: 4.70; 95% CI: 1.50 to 14.80). The incidence of calcification was associated with hypertension (OR: 2.20; 95% CI: 1.07 to 4.40). Higher cholesterol levels were associated with incidence of lipid cores (multivariate adjusted OR per unit increase in cholesterol: 1.40; 95% CI: 1.10 to 1.70).

Conclusions In these community-dwelling subjects, characteristics of plaque composition changed dramatically within a few years, and cardiovascular risk factors played a major role in these changes. Hypertension and its treatment and serum cholesterol levels were the main risk factors for the development of atherosclerotic plaque components over time.

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Footnotes

Dr. Franco has received a grant from Nestle on child health; and a grant from Metagenics on epigenetics and women's health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.