Diameter Reduction Determined Through Carotid Ultrasound Associated With Cardiovascular and All‐Cause Mortality: A Single‐Center Experience of 38 201 Consecutive Patients in Taiwan

Abstract

Background Few studies have evaluated the prognostic significance of diameter‐based carotid sonographic measurements for mortality. We investigated whether a reduction in diameter of different carotid anatomical segments is associated with cardiovascular and all‐cause mortality in a hospital‐based cohort with universal health care. Methods and Results We conducted a retrospective cohort study of 38 201 patients who underwent carotid duplex ultrasound at a medical center in Taiwan. Carotid sonographic parameters were the diameter reduction percentage in carotid bifurcation, the internal carotid artery, the common carotid artery, and the external carotid artery and the overall carotid atherosclerotic burden score, determined by summing the scores from all segments. The vital status was ascertained by linking data to National Death Registry until 2017. During a median follow‐up of 4.2 years, 5644 participants died, with 1719 deaths attributable to cardiovascular diseases. The multivariable‐adjusted hazard ratios (HRs; 95% CIs) for cardiovascular mortality were 1.33 (1.16‒1.53), 1.58 (1.361.84), and 1.89 (1.58, 2.26) for participants with 30% to <40%, 40% to <50%, and ≥50% reduction in carotid bifurcation diameter, respectively, compared with participants with <30% diameter reduction ( P for trend <0.001). The corresponding HRs (95% CIs) for all‐cause mortality were 1.25 (1.16‒1.34), 1.42 (1.31‒1.54), and 1.60 (1.45‒1.77), respectively. Diameter reduction at other carotid sites and the carotid atherosclerotic burden score exhibited the same dose–response relationship. Conclusions This study suggests that reduction in carotid artery diameter, which can be determined through routinely available sonography, is an independent risk factor for all‐cause and cardiovascular mortality.

Life's Essential 8 and carotid artery plaques: the Swedish cardiopulmonary bioimage study

“…Atherosclerosis is firmly established as a leading cause of clinical cerebrovascular events ( 1 ), and carotid plaques are feasible and useful markers of cardiovascular risk since they are indicators of the general atherosclerotic burden on the arterial tree ( 5 ). Thus, the burden and characteristics of atherosclerosis in the carotid arteries are associated with the atherosclerosis in other regions, such as the coronary arteries ( 6 ), and the grade of carotid stenosis has proven to be an independent risk factor for cardiovascular and all-cause mortality ( 5 ). Additionally, carotid plaques play an important role in the development of ischemic stroke, not only as a proxy of the atherosclerotic burden, but also due to formation and release of thromboemboli following carotid plaque rupture ( 7 ).…”

Common carotid artery diameter and the risk of cardiovascular disease mortality: a prospective cohort study in northeast China

“…However, the association between CCA diameter and CVD mortality was not explored in those studies, leaving the prognostic value of CCA for CVD unclear. Additionally, a retrospective cohort study conducted in Taiwan, China, reported an independent association between reduced CCA diameter and CVD mortality [ 16 ]. This finding contrasts with our results.…”