Abstract 19124: Detection and Prevalence of Systemic Atherosclerosis: Results from the High-Risk Plaque (HRP) Initiative
Background Most studies examining the burden of atherosclerosis involve a single anatomic territory. Such approaches, however, underestimate the true prevalence of vascular disease as atherosclerosis is a systemic, rather than focal, process. We sought to determine the prevalence and clinical correlates of systemic polyvascular atherosclerosis in an asymptomatic US population.
Methods In the High-Risk Plaque (HRP) Initiative, 5823 asymptomatic adults underwent multimodality non-invasive imaging for evaluation of subclinical atherosclerosis in the carotid and coronary arteries using duplex ultrasound and computed tomography (CT). Subclinical atherosclerosis was defined as presence of any coronary calcification (score > 0) or any focal carotid plaque. Patients were categorized by number of vascular territories with atherosclerosis (0, 1 or 2) and by quartiles of carotid atherosclerotic burden.
Results Any subclinical atherosclerosis was common, detectable in 87.8% (n=5113) of participants. While 1772 (30.4%) of individuals had involvement of either the coronary or carotid arteries alone, 3341 (57.4%) had involvement of both territories. Significant clinical correlates of polyvascular atherosclerosis included male gender, older age, diabetes mellitus, white race, smoking status and systolic blood pressure (p <0.001). The positive predictive value (PPV) for detecting any carotid plaque with an abnormal calcium score was 85% while the PPV for any coronary calcium with carotid plaque was 74%. In addition, the prevalence of coronary calcification increased in a step-wise fashion with greater carotid atherosclerotic burden (Figure).
Conclusion In the HRP Initiative, traditional risk factors correlated strongly with greater prevalence of subclinical atherosclerosis. Testing in one territory is strongly associated with probability of disease in the remaining vascular bed, highlighting the systemic nature of atherosclerosis.
- © 2012 by American Heart Association, Inc.