Korean Circ J.  2009 Aug;39(8):317-321. 10.4070/kcj.2009.39.8.317.

Prevalence and Significance of Carotid Plaques in Patients With Coronary Atherosclerosis

• Kwon TG
• Kim KW
• Park HW
• Jeong JH
• Kim KY
• Bae JH

• KMID: 2225681
• DOI: http://doi.org/10.4070/kcj.2009.39.8.317

Abstract

BACKGROUND AND OBJECTIVES
Carotid artery intima-media thickness (CIMT) has recently been recommended as a non-invasive tool for primary prevention of cardiovascular events; the association between CIMT and adverse cardiovascular events is well-known. We sought to evaluate the prevalence and significance of carotid artery plaque, especially in patients with coronary atherosclerosis. SUBJECTS AND METHODS: The study population consisted of 1,705 consecutive patients {933 males (54.7%); mean age, 59.7+/-10.9 years} who underwent coronary angiography and carotid artery scanning using high-resolution ultrasonography. Carotid plaque was defined as a focal structure encroaching into the arterial lumen by at least 50% of the surrounding IMT value or a thickness >1.2 mm. RESULTS: Carotid plaque was identified in 30.3% (516/1,705) of the patients. Of patients in whom the plaque location could be evaluated (n=1,027), carotid plaque was located at the common carotid artery {n=64/267 (24.0%)}, carotid bulb {n=194/267 (72.7%)}, and at both sites {n=9/267 (3.4%)}. The prevalence of hypertension (58.5% vs. 45.2%, p<0.001) and diabetes mellitus (30.6% vs. 23.5%, p=0.007) was higher in patients with carotid plaques. The patients with carotid plaques were older (65.4+/-8.9 years vs. 57.2+/-10.7 years, p<0.0001), had a thicker CIMT (0.89+/-0.20 mm vs. 0.77+/-0.16 mm, p<0.001), and higher fasting blood sugar (FBS) levels (132.1+/-60.7 mg/dL vs. 121.6+/-47.1 mg/dL, p<0.001) than those without carotid plaque. Patients with carotid plaque more frequently presented with acute coronary syndrome (32.4% vs. 23.9%, p<0.001) than those without carotid plaque. Significant coronary artery stenosis by coronary angiography (75.4% vs. 58.3%, p<0.001), especially multi-vessel disease (46.3% vs. 27.2%, p<0.001), was more frequent in patients with carotid plaques. On multivariate analysis, old age (> or =65 years), hypertension, and increased CIMT (> or =1.0 mm) were independent predictors of carotid plaque. Carotid plaque (odds ratio, 1.85; 95% confidence interval, 1.39-2.45; p<0.001) was an independent predictor of multivessel disease based on multivariate regression analysis. CONCLUSION: Carotid plaque was common (30.3%) in Korean patients with coronary atherosclerosis, but it is still relatively uncommon compared to Western populations. Carotid plaque was associated with old age, hypertension, and increased IMT, and was an independent predictor of multi-vessel disease.

Keyword

Carotid arteries; Atherosclerosis; Coronary artery disease

MeSH Terms

Acute Coronary Syndrome
Atherosclerosis
Blood Glucose
Carotid Arteries
Carotid Artery, Common
Carotid Stenosis
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Diabetes Mellitus
Fasting
Humans
Hypertension
Male
Multivariate Analysis
Prevalence
Primary Prevention
Blood Glucose

Figure

• 

  Fig. 1 Location of carotid plaque. Carotid plaque was founded more frequently in the carotid bulb (72.7%, n=194) than the common carotid artery (24.0%, n=64). Carotid plaque was found at the left carotid artery (40.8%, n=109) as well as the right carotid artery (38.2%, n=102) and at both carotid arteries (21.0%, n=56). CCA: common carotid artery, Lt. CA: left carotid artery, Rt. CA: right carotid artery.

• 

  Fig. 2 Coronary artery disease according to carotid plaque. Significant coronary artery stenosis by coronary angiogram (75.4% vs. 58.3%, p<0.001), especially multi-vessel disease (46.3% vs. 27.2%, p<0.001), were more frequent in patients with carotid plaque. *p<0.001. CAD: coronary artery disease, DS: diameter stenosis.

• 

  Fig. 3 Coronary artery disease according to the location of plaque. A: patients with carotid plaque in the bulb had a higher incidence of significant coronary artery stenosis than those with plaque in the CCA (66.0% vs. 89.1%, p<0.001), and multi-vessel disease was more frequent in patients with plaque involving the CCA and bulb than those with plaque involving the bulb (43.8% vs. 88.9%, p=0.012). B: patients with plaques in both carotid arteries had a higher incidence of significant coronary artery stenosis (83.9% vs. 69.2%, p=0.03) and multi-vessel disease (67.9% vs. 42.7%, p=0.001) than those with plaque in a single carotid artery. *p<0.001, †p=0.012, ‡p=0.03. CCA: common carotid artery, CAD: coronary artery disease, DS: diameter stenosis.

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