Author + information
- Received December 7, 2011
- Revision received March 16, 2012
- Accepted March 16, 2012
- Published online July 1, 2012.
- Henrik Sillesen, MD, DMSc⁎,⁎ (, )
- Pieter Muntendam, MD†,
- Aram Adourian, PhD†,
- Robert Entrekin, MSc‡,
- Mario Garcia, MD§,
- Erling Falk, MD, DMSc∥ and
- Valentin Fuster, MD, PhD¶,#
- ↵⁎Reprint requests and correspondence:
Dr. Henrik Sillesen, Department of Vascular Surgery, RK, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK 2100 Copenhagen O, Denmark
Objectives The purpose of this study was to compare carotid plaque burden, carotid intima-media thickness (cIMT), ankle-brachial index (ABI), and abdominal aortic diameter (AAD) to coronary artery calcium score (CACS) in people without known cardiovascular disease.
Background The clinical utility of risk factors to predict cardiovascular events is limited. Detection of subclinical atherosclerosis by noninvasive tests such as CACS, cIMT, carotid plaque burden, AAD, and ABI may improve risk prediction above that of established risk scoring models, namely, Framingham Risk Score.
Methods The High Risk Plaque BioImage study investigated 6.101 asymptomatic persons and reports baseline CACS, cIMT, ABI, and AAD. In addition, we present findings from a new 3-dimensional–based ultrasound approach, where the carotid artery was investigated in cross section from proximal in the neck to as distal as possible. From the resulting 10-s video, plaque was outlined on cross-sectional images and all plaque areas were summarized into “plaque burden.”
Results The mean age was 68.8 years, and 65.3% of subjects had intermediate Framingham Risk Score (6% to 20% 10-year risk). Carotid plaques were identified in 78% of cases, abnormal ABI in 10%, AAD >20 mm in 28%, and coronary calcium in 68% of participants. Carotid plaque burden was found to correlate stronger with CACS (chi-square 450, p < 0.0001) than did cIMT (chi-square 24, p < 0.0001), AAD (chi-square 2.9, p = 0.091), and ABI (chi-square 35.2, p < 0.0001).
Conclusions In the BioImage study, a new 3-dimensional–based ultrasound method identified more carotid plaques than in previous studies. Compared to other methods, carotid plaque burden was the strongest cross-sectional predictor of CACS, and its clinical utility as predictor of future cardiovascular events is being evaluated in the BioImage study. (BioImage Study: A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population; NCT00738725)
- aortic diameter
- cardiovascular disease
- cardiovascular risk prediction
- carotid plaque
- coronary calcium
Drs. Sillesen, Garcia, Falk, and Fuster have received honoraria from BG Medicine. Dr. Sillesen has also received honoraria from Philips Ultrasound. Drs. Muntendam and Adourian are employees and shareholders in BG Medicine Inc. Mr. Entrekin is an employee and shareholder in Philips Healthcare. Sherif Nagueh, MD, served as Guest Editor for this paper.
- Received December 7, 2011.
- Revision received March 16, 2012.
- Accepted March 16, 2012.
- American College of Cardiology Foundation