Hypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults aged 65 years or older. Cardiovascular Health Study.

Polak, J F; Shemanski, Lynn; O'Leary, D H; Lefkowitz, David M.; Price, Thomas R.; Savage, Peter J.; Brant, William E.; Reid, C.

doi:10.1148/radiology.208.3.9722841

Cited by 375 publications

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“…We adopted the same ultrasonography protocol used in one of the largest population-based studies of carotid atherosclerosis among elderly Americans [the Cardiovascular Health Study (CHS)]. 2,5 A single trained physician (A.K.) conducted the ultrasonographic scanning and interpreted the results.…”

Section: Baseline Examinationmentioning

confidence: 99%

“…[1][2][3][4] Furthermore, 2 prospective studies have investigated the association between echogenicity of plaques or carotid artery lesions and stroke risk in American populations; 1 study indicated that hypoechoic plaque was associated with increased risk of ischemic stroke, 5 and the other study implied that acoustic shadowing on carotid artery lesions is predictive of ischemic stroke. 6 In Asian countries, a previous follow-up study of Japanese patients with cardiovascular diseases or high-risk profiles showed a positive association between the severity of carotid plaque and the risk of ischemic stroke, 7 but no prospective study has been conducted in a general population.…”

mentioning

confidence: 99%

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Carotid Intima-Media Thickness and Plaque Characteristics as a Risk Factor for Stroke in Japanese Elderly Men

Kitamura

Iso

Imano

et al. 2004

Stroke

261

177

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Background and Purpose-Few cohort studies have examined the association of carotid intima-media thickness (IMT) and plaque characteristics with the risk of stroke in apparently healthy persons. We examined the relationship of carotid IMT and the surface, morphology, and calcification of carotid plaques with the incidence of stroke among Japanese men. Methods-Carotid IMT and plaque were evaluated bilaterally with ultrasonography in 1289 men aged 60 to 74 years without a previous stroke or coronary heart disease. In this cohort, the subsequent incidence of stroke was investigated. Results-During the 4.5-year follow-up, 34 strokes occurred. The multivariate-adjusted relative risk (95% CI) for the highest versus lowest quartiles of maximum IMT of the common carotid artery (CCA; Ն1.07 versus Յ0.77 mm) was 3.0 (1.1 to 8.3) for stroke. The combination of CCA and internal carotid artery (ICA) wall thickness was a better predictor of the risk of stroke than was CCA wall thickness alone. Men with a plaque, defined as a focal wall thickness of Ն1.5 mm, in the ICA had a 3-fold higher risk of stroke than those without a plaque, and the plaque surface irregularity further increased the stroke risk. A significant excess risk of stroke was confined to men with an uncalcified plaque. Key Words: atherosclerosis Ⅲ carotid artery Ⅲ epidemiology Ⅲ risk factors Ⅲ stroke P rospective population-based studies in Europe and the United States have documented that carotid intima-media thickness (IMT) and plaque are positively associated with the subsequent incidence of stroke. 1-4 Furthermore, 2 prospective studies have investigated the association between echogenicity of plaques or carotid artery lesions and stroke risk in American populations; 1 study indicated that hypoechoic plaque was associated with increased risk of ischemic stroke, 5 and the other study implied that acoustic shadowing on carotid artery lesions is predictive of ischemic stroke. 6 In Asian countries, a previous follow-up study of Japanese patients with cardiovascular diseases or high-risk profiles showed a positive association between the severity of carotid plaque and the risk of ischemic stroke, 7 but no prospective study has been conducted in a general population. The aim of this prospective study was to systematically examine the incidence of stroke in relation to carotid IMT and the surface, morphology, and calcification of carotid plaque in community-dwelling Japanese elderly men. Conclusions-Increased Subjects and Methods Study PopulationSubjects comprised 1358 men aged 60 to 74 years who were all participants of the target ages in a cardiovascular risk survey between 1996 and 2000. Subjects lived in 1 urban and 2 rural communities in Japan (Minamitakayasu district in Yao City, an urban community in Osaka Prefecture, 278 miles west of Tokyo, with a total census of 23 552 in 2000; Ikawa town, a rural community in Akita Prefecture, 280 miles northeast of Tokyo, with a total census of 6116; and Noichi town, a rural community in Kochi Prefecture, 393 miles sout...

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Section: Baseline Examinationmentioning

confidence: 99%

mentioning

confidence: 99%

Carotid Intima-Media Thickness and Plaque Characteristics as a Risk Factor for Stroke in Japanese Elderly Men

Kitamura

Iso

Imano

et al. 2004

Stroke

261

177

View full text Add to dashboard Cite

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“…Recent population-based studies have indicated that soft stenotic plaques harbor a higher risk of clinical cerebrovascular disease than hard stenotic plaques. 15,16 Whether these morphological structures could be related to metabolic changes reflected by HbA 1c levels has not been examined previously.…”

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confidence: 99%

Glycated Hemoglobin Level Is Strongly Related to the Prevalence of Carotid Artery Plaques With High Echogenicity in Nondiabetic Individuals

et al. 2004

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Background-High levels of HbA 1c have been associated with increased mortality and an increased risk of atherosclerosis assessed as carotid intima-media thickness or plaque prevalence. In the present population-based study, we examined the association between HbA 1c and plaque prevalence with emphasis on plaque echogenicity in subjects not diagnosed with diabetes. Methods and Results-HbA 1c measurements and ultrasonography of the carotid artery were performed in 5960 subjects (3026 women, 2934 men) 25 to 84 years of age. Plaque morphology was categorized into 4 groups from low echogenicity (soft plaque) to strong echogenicity (hard plaque

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“…Recent evidence, however, suggests that plaque composition, rather than its hemodynamic effect, is a better predictor of outcome (1). Specifically, a thin or ruptured fibrous cap and a large lipid core seem to relate to risk of stroke (2,3). Previous work has shown that MRI can characterize the composition of human atherosclerotic plaques both ex vivo (4 -6) and in vivo (7,8).…”

mentioning

confidence: 99%

Wash‐in kinetics for gadolinium‐enhanced magnetic resonance imaging of carotid atheroma

Wasserman

Casal

Astor

et al. 2004

Magnetic Resonance Imaging

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Purpose:To determine the wash-in kinetics of intravenous gadolinium into the fibrous cap and lipid core of carotid atheroma, and identify the time following gadolinium administration that maximizes contrast between the cap and core. Materials and Methods:Seven subjects with carotid artery stenosis were studied. Magnetic resonance (MR) images of the atheroma were acquired using a single-inversion-recovery fast-spin-echo (IR FSE) sequence, which was serially repeated during the first 30 minutes following intravenous gadolinium administration. Postcontrast time was divided into three intervals: Ͻ10, 11-20, and Ͼ21 minutes. Adjusted signal intensity (SI), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) values for postcontrast images were compared to adjusted precontrast values. Results:The mean SNRs of the cap and core were significantly elevated in each postcontrast interval compared with mean precontrast values. The CNRs of the cap vs. the core increased by 19.8% (3.03 to 4.14, P ϭ 0.03) in the first 10 minutes following gadolinium administration, and remained elevated over the next two intervals with a slight decrease in the final interval. Conclusion:Increased signal and contrast between the cap and core can be achieved by imaging up to 30 minutes following gadolinium administration, with peak enhancement occurring in the first 10 minutes.

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Hypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults aged 65 years or older. Cardiovascular Health Study.

Abstract: In asymptomatic adults aged 65 years or older, that risk of incident stroke was associated with two US features: hypoechoic internal carotid arterial plaque and an estimated internal carotid arterial stenosis of 50%-100%.

Cited by 375 publications

References 0 publications

Carotid Intima-Media Thickness and Plaque Characteristics as a Risk Factor for Stroke in Japanese Elderly Men

Carotid Intima-Media Thickness and Plaque Characteristics as a Risk Factor for Stroke in Japanese Elderly Men

Glycated Hemoglobin Level Is Strongly Related to the Prevalence of Carotid Artery Plaques With High Echogenicity in Nondiabetic Individuals

Wash‐in kinetics for gadolinium‐enhanced magnetic resonance imaging of carotid atheroma

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