Assessment by Cardiovascular Magnetic Resonance, Electron Beam Computed Tomography, and Carotid Ultrasonography of the Distribution of Subclinical Atherosclerosis Across Framingham Risk Strata

doi:10.1016/j.amjcard.2006.08.028

The American Journal of Cardiology

Volume 99, Issue 3, 1 February 2007, Pages 310-314

https://doi.org/10.1016/j.amjcard.2006.08.028 Get rights and content

Screening for subclinical atherosclerosis has been advocated for individuals at intermediate global risk for coronary heart disease (CHD). However, the distribution of subclinical atherosclerosis test values across CHD risk strata is unknown. We studied a stratified random sample of 292 participants (mean age 59.5 years, 50% women) from the offspring cohort of the Framingham Heart Study who were free of clinically apparent cardiovascular disease. We assessed abdominal and thoracic aortic plaque burden by cardiovascular magnetic resonance (CMR), coronary artery calcification (CAC) and thoracic aortic calcification (TAC) by electron beam computed tomography, and common carotid intima-media thickness (C-IMT) by ultrasonography. We categorized the upper 20% of each measurement as a high level of atherosclerosis and evaluated these variables across clinically relevant Framingham CHD risk score strata (low, intermediate, and high risk). In age-adjusted analyses in men and women, correlations across CMR aortic plaque, CAC, TAC, and C-IMT were low (maximum r = 0.30 for CAC:TAC in women, p <0.005). In men and women, the proportion of subjects with high atherosclerosis test results for any of these measurements increased significantly across Framingham CHD risk score strata (Kruskal-Wallis test, p <0.0001). In the intermediate Framingham CHD risk score category, 14% of men and 25% of women had a high atherosclerosis result on ≥2 measurements. However, different participants were identified as having high atherosclerosis by each modality. For example, in a comparison of the overlap across CMR aortic plaque, CAC, and C-IMT, only 4% of men and 16% of women were classified as having high atherosclerosis on all 3 measurements. In conclusion, in a community-based sample, correlations among subclinical atherosclerosis test results are low, and a substantial proportion has high levels of subclinical atherosclerosis detected on ≥2 imaging tests.

Section snippets

Participants

The recruitment procedure has been previously described.¹ Briefly, the present study was designed as a pilot study to evaluate several subclinical atherosclerosis imaging tests in the Framingham Heart Study offspring cohort. The subjects represent a stratified sample of participants from the offspring cohort of the Framingham Heart Study. Initially recruited in 1971, the offspring cohort consisted of 5,124 subjects 5 to 70 years of age, and each subject has been examined approximately every 4

Results

Characteristics of the 292 participants (50% women) who underwent all 3 imaging techniques are listed in Table 1. Patients’ average age was 59.5 years (range 36 to 78). The distribution of test values for each measurement is presented in Table 2.

Spearman’s correlations across CMR aortic plaque, CAC, TAC, and C-IMT are listed in Table 3. In age-adjusted analyses in men and women, correlations across CMR aortic plaque, CAC, TAC, and C-IMT were low (maximum r = 0.30 for CAC:TAC in women, p

Discussion

In a community-based sample free of clinical cardiovascular disease, we evaluated subclinical atherosclerosis by 4 different imaging techniques: abdominal and thoracic aortic plaque burden by CMR, CAC and TAC by electron beam computed tomography, and C-IMT by ultrasonography. Our principal findings were (1) correlations across atherosclerotic measurements in the various major vascular beds were low; (2) subclinical atherosclerosis tests identified different participants at risk; and (3) in

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Association of descending thoracic aortic plaque with brain atrophy and white matter hyperintensities: The Framingham Heart Study
2017, Atherosclerosis
Aortic atherosclerosis is an aggregate marker of vascular risk factor exposure and has been associated with intracranial atherosclerosis and stroke. We hypothesized that atherosclerosis of the descending aorta (DAo) could be a risk marker for brain aging and injury.
We evaluated 1527 participants (mean age 59.9 years, 53.5% women) in the Framingham Offspring cohort who underwent both aortic and brain MRI. Participants were free of clinical stroke, dementia, or other neurological illness at the time of axial MRI of the thoracic and abdominal DAo and subsequent brain MRI. We related the prevalence and burden of aortic plaque to total cerebral brain volume (TCBV) and white matter hyperintensity volume (WMHV). An additional analysis compared incidence of stroke or TIA in participants with and without DAo plaques.
Presence of thoracic DAo plaque (8%) was associated with decreased TCBV in sex-pooled analysis (−0.77, SE 0.25, p = 0.002, equivalent to 4.5 years of aging) and with increased WMHV only in men (0.26, SE 0.12, p = 0.032, equivalent to 6.5 years aging). We observed similar associations of DAo plaque burden with TCBV and WMHV. There were 43 strokes and 11 TIAs in prospective follow-up (median 7 years). Presence of DAo plaque was not associated with subsequent stroke or TIA.
In this cross-sectional community-based study, we found DAo plaque is associated with accelerated brain aging. These data underscore the potential implications of incidentally identified subclinical aortic atherosclerosis and question whether targeted intervention in these high risk individuals can modulate cognitive decline.
Neck circumference is associated with carotid intimal-media thickness but not with coronary artery calcium: Results from The ELSA-Brasil
2016, Nutrition, Metabolism and Cardiovascular Diseases
Citation Excerpt :
Also, they identified participants having a high atherosclerosis level for each test if the value was in the top 20% of the sex-specific distribution. For men and women, both CAC and c-IMT identified 30 participants with high atherosclerosis but only 13 participants were classified at high atherosclerosis level by both methods [31]. Another possibility to explain the positive association between neck circumference with cIMT could be a local effect of perivascular fat depots in the neck.
It is uncertain whether neck circumference can be a risk indicator for subclinical atherosclerosis. We aimed to investigate their relationships measured by coronary artery calcium (CAC) and common carotid intima-media thickness (cc-IMT) with neck circumference in ELSA-Brasil.
In cross-sectional and sex-specific analyses of 2266 women (50.6 ± 8.4 yrs) and 1886 men (50.7 ± 9.0 yrs) with both cc-IMT and CAC, free from previous cardiovascular disease at baseline, we built logistic models using diverse cut-off points for CAC score (0 vs >0, <100 vs ≥100, <400 vs ≥400 Agatston units) and cc-IMT (<75th percentile vs ≥75th; <90th percentile vs ≥90th) as dependent variables, after which adjustments for age and traditional cardiovascular risk factors were made. Mean neck circumference was 33.6 (±2.4 cm) for women and 38.8 (±2.6 cm) for men. In fully adjusted models including sociodemographic, cardiovascular risk factors and body-mass index and waist circumference, for each 1 standard deviation increase in neck circumference we found an odds ratio (OR, 95% CI) for IMT above the 75th percentile of (1.52, 1.16; 1.99) for women and (1.66, 1.28; 2.14) for men, and above the 90th cc-IMT percentile [1.66 (1.19; 2.32) for men but not for women [1.21 (0.80; 1.82)]. We found no association between neck circumference and CAC using different cut-off points (p > 0.05 for all).
Neck circumference was significantly and independently associated with cc-IMT but not with CAC in women and men, indicating a possible effect of perivascular fat tissue on atherosclerosis.
Non-invasive molecular imaging of vulnerable atherosclerotic plaques
2015, Journal of Cardiology
The growing discoveries coming from clinical and basic research during the past decades have revolutionized our knowledge regarding pathophysiologic mechanisms underlying the atherosclerotic process and its thrombotic complications.
The traditional view focusing on the severity of stenosis of atherosclerotic plaque has given way to the evidence that the clinical complications of atherosclerotic vascular disease, particularly the propensity to develop thrombotic complications, are determined mainly by the biological composition of the plaque.
This paradigm shift has reinforced the need to move from the sole anatomical assessment toward combined anatomic and functional imaging modalities enabling the molecular and cellular characterization of the disease on top of its structural properties.
Together, the progress to identify molecular targets related to plaque vulnerability and the improvement of imaging techniques for the detection of such molecular targets have allowed us to obtain new important pathophysiological information.
This might allow better patient stratification for the identification of subjects at high risk to develop premature atherosclerosis who might need an aggressive therapeutic approach.
Nuclear techniques, magnetic resonance imaging, computed tomography angiography, and contrast-enhanced ultrasound represent the currently available non-invasive imaging modalities for molecular imaging which can provide different and complementary insights into the biological features of the atherosclerotic process. This clinical review will discuss the evidence and potential translational applications of the individual imaging techniques particularly concerning their ability to detect the main atherosclerotic features related to plaque vulnerability, such as plaque inflammation and intertwined neovascularization.
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2013, JACC: Cardiovascular Imaging
The purpose of this study was to assess the relationship between carotid artery disease by ultrasound and coronary artery disease by coronary computed tomography angiography (CTA) and to identify carotid ultrasound parameters predictive of coronary artery disease.
Carotid ultrasound and CTA are noninvasive modalities used to image atherosclerosis. Studies examining the relationship between the 2 tests, however, are lacking.
We performed carotid ultrasound on predominantly nondiabetic subjects referred for CTA. Carotid intima media thickness (IMT) and plaque were assessed and compared with coronary artery calcification and the number of coronary arteries with any evidence of atherosclerosis on CTA.
A total of 150 subjects underwent both CTA and carotid ultrasound on the same day. Carotid plaque was present in 71.3% (n = 107), whereas the presence of at least 1 coronary artery with disease on CTA was present in 57.1% (n = 84). Carotid plaque was present in 47.6% (30 of 63) of subjects with a calcium score of 0 and 88.5% (77 of 87) of subjects with a calcium score >0 (p = 0.0001). Similarly carotid plaque was present in 52.4% (33 of 63) of subjects with no CTA evidence of atherosclerosis versus 85.7% (72 of 84) of subjects with any CTA evidence of atherosclerosis (p < 0.0001). Carotid plaque, IMT ≥1.5 mm, or averaged mean IMT >0.75 mm were associated with a calcium score >0 (odds ratio: 5.4, p < 0.0001, 2.7, p < 0.001; 2.9, p = 0.011, respectively) and disease in at least 1 vessel on CTA (odds ratio: 2.8, p = 0.03, 2.19, p = 0.073; 2.22, p = 0.058, respectively) independent of age and sex.
Carotid plaque and increased carotid IMT are associated with the presence and severity of coronary calcification and disease on CTA in ambulatory subjects.
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Peripheral artery disease (PAD) is a debilitating condition involving atherosclerosis. Although saturated, monounsaturated and polyunsaturated fatty acids have strong associations with atherosclerosis, it is unclear if diets high in these fatty acids affect PAD.
We studied 6352 adults aged 40 years and older who participated in the U.S. National Health and Nutrition Examination Survey between 1999 and 2004. Ankle brachial index (ABI) was assessed by standardized blood pressure measurements, and we defined PAD as an ABI < 0.9. Fatty acid intake was assessed by validated 24-h dietary recall. We used multivariable linear and logistic regression to estimate associations between intakes of dietary saturated fatty acids (SFAs), monounsaturated fatty acids (MFAs), marine omega-3 fatty acids (N-3), linolenic acid (LNA), and omega-6 fatty acids (N-6) and ABI/PAD.
The prevalence and 95% confidence interval (CI) of PAD was 5.2% (95% CI 4.6–5.8).
There were no associations between ABI and intakes of marine N-3 (p = 0.83) or N-6 (p = 0.19) in adjusted models. In contrast, LNA was associated with higher ABI (p = 0.04) and SFA tended to be associated with lower ABI (p = 0.06) in adjusted models. In addition, higher SFA was associated with a higher prevalence of PAD: adjusted odds ratio 1.30 (95% CI 1.01–1.67; p = 0.04) and a trend toward slower gait speed (p = 0.08).
In this nationally representative sample, higher dietary intakes of LNA and SFAs were associated with higher and lower ABI, respectively. Prospective studies are needed to confirm the potential protective effects of dietary LNA and detrimental effects of dietary SFAs on PAD.
Non-obstructive low attenuation coronary plaque predicts three-year acute coronary syndrome events in patients with hypertension: Multidetector computed tomographic study
2012, Journal of Cardiology
Citation Excerpt :
Arterial hypertension leads to progressive changes in left ventricular (LV) size and function, and vascular endothelial dysfunction due to sustained pressure load, with increased long-term cardiovascular risk and mortality. Several parameters are widely used in the global risk assessment for coronary artery disease (CAD) [e.g. the Framingham risk score, carotid intima-media thickness (IMT), and LV mass index] [1–3], but they have limited value in predicting acute coronary syndrome (ACS) events [4–6]. Accordingly, there is a need for more accurate diagnostic tools for ACS prediction, which should help clarify the pathogenic mechanisms of ACS in patients with hypertension as well as to identify the high-risk patients requiring more aggressive intervention.
Arterial hypertension is an established risk factor for acute coronary syndrome (ACS). Multidetector computed tomography (MDCT) is an accurate and less invasive technique for assessment of the degree of coronary artery luminal narrowing and characterization of coronary atherosclerosis. We therefore aimed to investigate the predictive power of MDCT for future ACS events and compared with traditional parameters in patients with hypertension.
One hundred and thirty-four patients (93 men, mean age 70 ± 11 years) with hypertension underwent MDCT for evaluation of coronary artery disease. MDCT analysis focused on the presence of plaques, the degree of stenosis, and the plaque characteristics. Traditional parameters included Framingham risk score, carotid intima-media thickness, and left ventricular mass index.
During a mean follow-up of 39 ± 10 months, ACS events occurred in 10 patients, including myocardial infarction (n = 3) and unstable angina (n = 7). Multivariate analysis identified total number of low attenuation plaques as an independent predictor of ACS events (p < 0.001).
We demonstrated that non-obstructive low attenuation coronary plaques on MDCT predicted more accurately future ACS events in patients with hypertension than traditional parameters.

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: This study was supported by the Framingham Heart Study of the National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland, and Boston University School of Medicine, Boston, Massachusetts (Grant N01-HC-25195).

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Coronary artery diseaseAssessment by Cardiovascular Magnetic Resonance, Electron Beam Computed Tomography, and Carotid Ultrasonography of the Distribution of Subclinical Atherosclerosis Across Framingham Risk Strata

Section snippets

Participants

Results

Discussion

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

C-reactive protein is associated with subclinical epicardial coronary calcification in men and women: the Framingham Heart Study

Circulation

An investigation of coronary heart disease in familiesThe Framingham Offspring Study

Am J Epidemiol

Age and sex distribution of subclinical aortic atherosclerosis: a magnetic resonance imaging examination of the Framingham Heart Study

Arterioscler Thromb Vasc Biol

Coronary artery disease
Assessment by Cardiovascular Magnetic Resonance, Electron Beam Computed Tomography, and Carotid Ultrasonography of the Distribution of Subclinical Atherosclerosis Across Framingham Risk Strata