Carotid and Femoral Atherosclerotic Plaques in Asymptomatic and Non-Treated Subjects: Cardiovascular Risk Factors, 10-Years Risk Scores, and Lipid Ratios’ Capability to Detect Plaque Presence, Burden, Fibro-Lipid Composition and Geometry

Abstract

Carotid and/or femoral atherosclerotic plaques (AP) assessment through imaging studies is an interesting strategy for improving individual cardiovascular risk (CVR) stratification and cardiovascular disease (CVD) and/or events prediction. There is no consensus on who would benefit from image screening aimed at determining AP presence, burden, and characteristics. Aims: (1) to identify, in asymptomatic and non-treated subjects, demographic factors, anthropometric characteristics and cardiovascular risk factors (CRFs), individually or grouped (e.g., CVR equations, pro-atherogenic lipid ratios) associated with carotid and femoral AP presence, burden, geometry, and fibro-lipid content; (2) to identify cut-off values to be used when considering the variables as indicators of increased probability of AP presence, elevated atherosclerotic burden, and/or lipid content, in a selection scheme for subsequent image screening. Methods: CRFs exposure and clinical data were obtained (n = 581; n = 144 with AP; 47% females). Arterial (e.g., ultrasonography) and hemodynamic (central [cBP] and peripheral blood pressure; oscillometry/applanation tonometry) data were obtained. Carotid and femoral AP presence, burden (e.g., AP number, involved territories), geometric (area, width, height) and fibro-lipid content (semi-automatic, virtual histology analysis, grayscale analysis and color mapping) were assessed. Lipid profile was obtained. Lipid ratios (Total cholesterol/HDL-cholesterol, LDL-cholesterol/HDL-cholesterol, LogTryglicerides(TG)/HDL-cholesterol) and eight 10-years [y.]/CVR scores were quantified (e.g., Framingham Risk Scores [FRS] for CVD). Results: Age, 10-y./CVR and cBP showed the highest levels of association with AP presence and burden. Individually, classical CRFs and lipid ratios showed almost no association with AP presence. 10-y./CVR levels, age and cBP enabled detecting AP with large surfaces (˃p75th). Lipid ratios showed the largest association with AP fibro-lipid content. Ultrasound evaluation could be considered in asymptomatic and non-treated subjects aiming at population screening of AP (e.g., ˃ 45 y.; 10-y./FRS-CVD ˃ 5–8%); identifying subjects with high atherosclerotic burden (e.g., ˃50 y., 10-y./FRS-CVD ˃ 13–15%) and/or with plaques with high lipid content (e.g., LogTG/HDL ˃ 0.135).

Physiological Age- and Sex-Related Profiles for Local (Aortic) and Regional (Carotid-Femoral, Carotid-Radial) Pulse Wave Velocity and Center-to-Periphery Stiffness Gradient, with and without Blood Pressure Adjustments: Reference Intervals and Agreement between Methods in Healthy Subjects (3–84 Years)

“…CV evaluation in the CUiiDARTE project includes assessing: (i) peripheral (brachial, radial, ankle) and central (aortic, carotid) BP levels; central (aortic, carotid) PWA and WSA-derived parameters (e.g., augmentation index, forward and backward pressure components), (ii) carotid, femoral and brachial beat-to-beat diameter waves and intima-media thickness, (iii) brachial artery reactivity (e.g., flow-mediated dilation; low flow-mediated constriction), (iv) carotid, femoral and brachial doppler-derived blood velocity profiles and resistive/pulsatile indexes, (v) ankle-brachial index, (vi) screening for carotid and femoral atherosclerotic plaques presence, (vii) carotid, femoral and brachial local stiffness (e.g., distensibility, elastic modulus), (viii) systemic hemodynamic evaluation (e.g., systemic vascular resistances, cardiac output and index quantified from brachial pulse contour analysis and/or cardiography impedance, (ix) regional stiffness (cfPWV, crPWV) [ 9 , 10 , 11 , 12 , 13 , 22 ]. In this work, we focused on regional and local PWV data.…”

“…Left and right common (CCA), internal and external carotid arteries and common femoral (CFA) arteries were examined (B-Mode and Doppler ultrasound, 7–13 MHz, linear transducer, M-Turbo, SonoSite Inc., Bothell, WA, USA) [ 22 ]. Transverse and longitudinal arterial views were obtained to assess the presence of atherosclerotic plaques.…”

Age- and sex-related profiles for macro, macro/micro and microvascular reactivity indexes: Association between indexes and normative data from 2609 healthy subjects (3-85 years)

“…The study was carried out in the context of the Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE) project [20][21][22][23][24][25][26][27], a population-based study developed in Uruguay. In this work, we considered data from 3619 subjects included in the CUiiDARTE Database.…”

“…Left and right common, internal and external carotid arteries, vertebral arteries and common femoral arteries were examined (B-Mode and Doppler ultrasound, 7-13 MHz, linear transducer, M-Turbo, SonoSite Inc., Bothell, WA, USA) [26,27]. Transverse and longitudinal views (from different angles) were obtained to assess atherosclerotic plaques presence.…”

“…Transverse and longitudinal views (from different angles) were obtained to assess atherosclerotic plaques presence. An atherosclerotic plaque was defined as focal wall thickening at least 50% greater than adjacent segments; focal thickening protruding into the lumen at least 0.5 mm and/or an intima-media thickness �1.5 mm [26,27].…”