Influence of classical risk factors on carotid total plaque area progression

PAUL ATKINS; HERNAN A. PEREZ; NESTOR H. GARCIA; J DAVID SPENCE; SONIA E MUNOZ

Quebec

Congreso; 5th ICCR Congress on Chronic Societal Cardiometabolic Diseases; 2015

Chronic Societal Cardiometabolic Diseases

Objective: To determine the influence of cardiovascular risk factors on carotid total plaquearea progression.Methods: Data were obtained from the patient database of Blossom DMO, a primaryprevention program in Córdoba, Argentina, from 2004 until present. The database includes4,351 patients in total, composed of 2659 men, 2163 hypertensive patients, 877 diabetics,2433 active smokers, 1315 individuals with family history of early cardiovascular disease(CVD) and 3726 with BMI >25 kg/m2. During each follow-up visit, risk factor informationwas obtained and current Framingham risk score based on BMI was determined. Inaddition, at each visit duplex ultrasound was used to measure carotid total plaque area(TPA), a highly sensitive measure of subclinical atherosclerosis that effectively predictsfuture CVD risk. To determine the influence of cardiovascular risk factors on the carotidtotal plaque area progression, we fitted a generalized linear model using TPA as theresponse variable with gamma distribution and log link function, age as a continuousvariable, and all other variables as explicative factors in the linear predictor.Results The adjusted model showed that TPA progressed at a rate of 1.02 ±1.08 cm2/yearin patients with no risk factors. In diabetic patients, TPA progression was 1.22±1.05cm2/year; in smokers, 1.34±1.04 cm2/year; and in hypertension, 1.57±1.04 cm2/year. In thepresence of a family history of early CVD, TPA progression was 1.08±1.06 cm2/year. BMIalone did not influence TPA progression. Further, there was significant interaction amongthe risk factors, namely hypertension & diabetes, hypertension & smoking, and diabetes &smoking, suggesting a multiplicative effect rather than an additive one.Conclusions. Our data indicate that TPA progression is significantly determined by age,diabetes, smoking, family history of early CVD, and hypertension, and that the presence ofat least two concurrent classical risk factors potentiates TPA growth. Therefore,determination of TPA in patients with intermediate Framingham risk may be required tobetter stratify the risk of these patients and treat accordingly.