Influence of classical risk factors on carotid total plaque area progression

ATKINS P; PÉREZ HA; GARCÍA NH; SPENCE JD; MUÑOZ SE

Amsterdam

Simposio; International Symposium of Atherosclerosis.; 2015

International Atherosclerosis Society

Objective: To determine the influence of cardiovascular risk factors on carotid total plaque area progression.Methods: Data were obtained from the patient database of Blossom DMO, a primaryprevention program in Córdoba, Argentina, from 2004 until present. The database includes 4,351 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 information was obtained and current Framingham risk score based on BMI was determined. In addition, 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 carotid total plaque area progression, we fitted a generalized linear model using TPA as the response variable with gamma distribution and log link function, age as a continuous variable, 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/year in patients with no risk factors. In diabetic patients, TPA progression was 1.22±1.05 cm2/year; in smokers, 1.34±1.04 cm2/year; and in hypertension, 1.57±1.04 cm2/year. In the presence of a family history of early CVD, TPA progression was 1.08±1.06 cm2/year. BMI alone did not influence TPA progression. Further, there was significant interaction among the 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 of at least two concurrent classical risk factors potentiates TPA growth. Therefore, determination of TPA in patients with intermediate Framingham risk may be required to better stratify the risk of these patients and treat accordingly.