Research Article
A risk score for carotid plaque as an assessment risk of cardiovascular risk among patients with hypertension

https://doi.org/10.1016/j.jash.2018.11.001Get rights and content

Highlights

  • To show the current status of carotid plaque in patients with hypertension.

  • To develop a simple scoring system to predict the risk of carotid plaque.

  • The prediction model shows good discriminant power and calibration.

  • Traditional risk factors of cardiometabolic disease play different effects on carotid plaque.

Abstract

This study aimed to describe the status of carotid plaques and develop a simple scoring system to predict the risk of carotid lesions in patients with hypertension. Basic testing for carotid plaques was carried out and used for risk score development (the training dataset, n = 2665) and validation (the test dataset, n = 1333). Independent predictors of carotid plaques from the multivariate model were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver operating characteristic analysis using the test dataset. A total of 1346 of 2665 patients were examined for carotid plaques, which were more frequent in men than in women, and increased with age. The final model included eight significant variables, and these variables were then used to develop a risk score for the prediction of carotid plaques. Receiver operating characteristic analysis demonstrated good discriminant power with a C-statistic of 0.732 (95% confidence interval: 0.713–0.751) and good calibration across quantiles of observed predicted risk (74.6%). We developed a simple risk score for the prediction of carotid plaques based on eight variables. The prediction model showed good discriminant power and calibration.

Introduction

Previous studies showed that intima-media thickness (IMTs) and plaque were highly predictive of coronary and cerebrovascular disease, per 1-standard deviation (SD) IMT increase was associated with a 30%–40% increased risk of myocardial infarction (MI) and ischemic stroke, and the presence of carotid plaques was a stronger predictor of cardiovascular disease (CVD) risk compared with IMT.1, 2, 3, 4 B-mode ultrasound of carotid arteries has been widely used to assess plaques and was recommended for cardiovascular risk assessment in asymptomatic adults at intermediate risk by the American Heart Association.5

B-mode ultrasound of carotid arteries is not available for routine use in risk assessment in asymptomatic adults in China. In addition, carotid plaques are strongly associated with age, as the case detection rate was more than 70% in persons aged ≥60 years,6, 7 large number of persons at high risk of CVD were detected, and opposite results were found in persons aged <45 years. B-mode ultrasound has low specificity among old persons and low sensitivity among young persons for carotid plaques and is widely used as a surrogate measure of CVD. So carotid plaques should be assessed in combination with traditional factors of CVD for primary prevention in high-risk patients.

Previous studies have demonstrated that traditional risk factors for ischemic CVDs (ISCVD) such as age, hypertension, hyperglycemia, high cholesterol, and smoking also increase the risk of carotid atherosclerosis,8, 9, 10 but the effects of these factors are not consistent. Cholesterol, hypertension, and smoking are the most relevant factors for ISCVD, whereas the most important factors for carotid plaque are age, hypertension, and smoking in Chinese adults.6, 8 Therefore, in this study, we developed a risk score based on the relevant factors for carotid plaque in patients with hypertension. This risk score will help clinicians to make informed decisions regarding carotid ultrasound scanning, and both lifestyle and pharmacologic interventions to reduce CVD risk and increase the accuracy of predicting ISCVD.

Section snippets

Participants

This cross-sectional survey was conducted from June 2016 to June 2017. We prospectively recruited patients with hypertension who visited hypertension clinics and performed carotid artery ultrasound examinations in Anzhen Hospital, Beijing, China. The inclusion criteria were as follows: (1) patients aged 35–74 years; and (2) patients with a medical history of hypertension for a minimum of 3 months. The exclusion criteria were as follows: (1) patients with familial hypercholesterolemia; and (2)

General Information on Patients in the Training and Test Datasets

A total of 3998 patients with hypertension were recruited (Figure 1). The training dataset included 2665 patients with a mean age of 57.8 years (range 39–74 years, SD = 8.2), and 32.7% (871) were male. The test dataset included 1333 patients with a mean age of 57.2 years (range 40–74 years, SD = 8.1), and 33.4% (445) were male. No significant differences were identified in their characteristics, with the exception of a family history of ISCVD between the two groups. The general characteristics

Conclusions

Carotid artery plaques are early predictors of atherosclerotic CVD (ASCVD).1, 2, 3, 4 Therefore, patients with carotid plaques are screened and receive primary preventive measures as they are considered to be at high risk of ASCVD. In this study, based on multiple logistic regression, eight significant indicators were identified and were then used to create a clinical scoring system to identify patients at high risk of carotid plaques and ASCVD. Based on this scoring system, clinical staff will

Acknowledgments

This study was funded by the Beijing Municipal Health Bureau, China (TG-2015-33). The authors thank all the experienced operators for ultrasound scanning and measurement which resulted in high-quality results. They also thank International Science Editing (http://www.internationalscienceediting.com) for editing this article.

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  • Cited by (0)

    Research progress and transformation of scientific and technological achievements in heart lung and blood vessel diseases was funded by the Beijing Municipal Health Bureau (TG-2015-33).

    Conflict of interest: The authors declare that they have no competing interests.

    1

    These authors contributed equally to the study and are considered as co-first authors. The co-first authors made the greatest contribution to the article.

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