Features and risk factors of carotid atherosclerosis in a population with high stroke incidence in China

Abstract

Epidemiological studies have reported associations between traditional cardiovascular risk factors and carotid intima-media thickness (CIMT) or carotid plaque. However, definite risk factors at different phases of carotid atherosclerosis remain controversial. We aimed to explore risk factors and characteristics of carotid atherosclerosis at different stages in a low-income population with a high incidence of stroke in China. Between April 2014 and January 2015, we recruited 3789 stroke-free and cardiovascular disease-free residents aged ≥ 45 years. B-mode ultrasonography was performed to measure CIMT and the presence of carotid plaque. Traditional risk factors were compared between the increased CIMT group and normal CIMT group, and between those with and without carotid plaque. A total of 3789 participants were assessed in this study, with a mean age (standard deviation) of 59.92 (9.70) years. The prevalence of increased CIMT and carotid plaque increased with older age and higher education levels. Age, hypertension, diabetes, and high low-density lipoprotein cholesterol levels were risk factors for increased CIMT and carotid plaque. Furthermore, compared to never smoking, passive smoking was positively associated with increased CIMT, with an odds ratio (95% confidence interval) of 1.26 (1.05, 1.53; P = 0.016); high body mass index was an obvious protective factor against carotid plaque, with an odds ratio (95% confidence interval) of 0.97 (0.95, 0.99; P = 0.004). It is important to identify factors associated with atherosclerosis to prevent cardiovascular disease and stroke and reduce the burden of stroke in this high-risk population.

Carotid Atherosclerosis Detected by Ultrasonography: A National Cross‐Sectional Study

“…Of the studies that excluded people with prior CVDs, the prevalence of carotid plaque was 9.7% in villages in Xinjiang, 17 18.8% in Shanghai city, 18 16.8% to 30.6% in Nanjing city, 19 and 41.5% in a low-income rural community in Tianjin. 20 The reported overall prevalence of CA or increased IMT was from 11.2% in a rural community in Shandong 21 to as high as 40.3% in Shenyang city. 22 Different approaches in participant sampling and selection, ultrasound techniques, and diagnosis criteria may cause such substantial differences in the reported prevalence of CA and carotid plaque, although it is generally impossible to be certain based on published literature.…”

“…To compare our results with previous studies, we searched PubMed to identify population‐based studies that reported the prevalence of CA detected by ultrasound in China, and summarized findings are shown in Table 4. Of these previous studies,16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 only the CKB (China Kadoorie Biobank) study included a large sample of participants (N=24 822) from multiple geographic regions in China16; all other studies were geographically local. The CKB study reported that the overall prevalence of carotid plaque was 31%, which was much higher than the prevalence of 13.9% in the present study; however, the CKB study included participants with stroke (5.4%) or coronary heart disease (7.5%).…”

“…The CKB study reported that the overall prevalence of carotid plaque was 31%, which was much higher than the prevalence of 13.9% in the present study; however, the CKB study included participants with stroke (5.4%) or coronary heart disease (7.5%). Of the studies that excluded people with prior CVDs, the prevalence of carotid plaque was 9.7% in villages in Xinjiang,17 18.8% in Shanghai city,18 16.8% to 30.6% in Nanjing city,19 and 41.5% in a low‐income rural community in Tianjin 20. The reported overall prevalence of CA or increased IMT was from 11.2% in a rural community in Shandong21 to as high as 40.3% in Shenyang city 22.…”

Association of Carotid Atherosclerosis With Lipid Components in Asymptomatic Low-Income Chinese: A Population-Based Cross-Sectional Study

“…The bilateral extracranial carotid artery trees (including the common carotid artery, carotid sinus, and internal and external carotid arteries) were screened for plaque. Carotid plaque is defined as: (1) local CIMT exceeds 1.5 mm, (2) localized CIMT bulge protrudes into the lumen for more than 0.5 mm, and (3) local CIMT exceeds 50% in the peripheral medial lining; early-stage atherosclerosis was defined as CIMT ≥1 mm (21,22). CIMT at the near and far walls of the common carotid artery was measured on the left and the right, and three values were obtained: maximum CIMT, minimum CIMT, and average CIMT per lateral.…”

User Preferences and Persona Design for an mHealth Intervention to Support Adherence to Cardiovascular Disease Medication in Singapore: A Multi-Method Study (Preprint)

“…Although medication has shown to be effective in preventing cardiovascular events associated with ASCVD 17 , patients may exhibit suboptimal adherence due to the long term management required, disease misperceptions, poor patient-physician relationship, weak social support and comorbidities [18][19][20][21] . The txt2heart trial is an international collaboration evaluating the efficacy and safety of SMS on clinical outcomes and adherence in different countries including Colombia, Ghana, India and Singapore.…”