Early subclinical atherosclerosis has been mainly researched in carotid arteries. The potential value of femoral arteries for improving the predictive capacity of traditional risk factors is an understudied area.
Objectives
This study sought to evaluate the association of subclinical carotid and femoral plaques with risk factors and coronary artery calcium score (CACS) in middle-aged men.
Methods
Participants (n = 1,423) of the AWHS (Aragon Workers’ Health Study), a study designed to assess cardiovascular risk and subclinical atherosclerosis in a cohort of middle-aged men (40 to 59 years of age), underwent carotid and femoral ultrasound plus noncontrast coronary computed tomography. Subclinical atherosclerosis was defined as the presence of any plaque in carotid or femoral arteries and/or CACS ≥1. Logistic regression models were used to estimate the prevalence of atherosclerosis adjusted for risk factors and age, to evaluate the association of atherosclerosis with risk factors, and to calculate areas under the receiver-operating characteristic curves for the presence of positive CACS.
Results
Subclinical atherosclerosis was found in 72% of participants. Plaques were most common in femoral arteries (54%), followed by coronary calcification (38%) and carotid plaques (34%). Association of atherosclerosis with risk factors was stronger in femoral arteries than carotid or coronary arteries. The area under the receiver-operating characteristic curve for prediction of positive CACS increased from 0.665 when considering only risk factors (dyslipidemia, current smoking, hypertension, diabetes, and age) to 0.719 when adding femoral and carotid plaques (p < 0.001). In this model, the femoral odds ratio (2.58) exceeded the carotid odds ratio (1.80) for prediction of positive CACS.
Conclusions
Subclinical atherosclerosis was highly prevalent in this middle-aged male cohort. Association with risk factors and positive CACS was stronger in femoral than carotid arteries. Screening for femoral plaques may be an appealing strategy for improving cardiovascular risk scales and predicting coronary disease.
Key Words
cohort
computed tomography
risk assessment
ultrasonography
Abbreviations and Acronyms
ASCVD
atherosclerotic cardiovascular disease
CACS
coronary artery calcification score
CT
computed tomography
CVD
cardiovascular disease
HDL
high-density lipoprotein
ROC
receiver-operating characteristic
Cited by (0)
The AWHS (Aragon Workers’ Health Study) is funded by the Instituto Aragonés de Ciencias de la Salud (I+CS) and the Spanish National Center for Cardiovascular Diseases (CNIC). Dr. Laclaustra was supported in part by grants FIS CP08/00112, PI10/00021, and PI14/00009 from the Instituto de Salud Carlos III, which includes FEDER funding. Dr. León-Latre was supported by FIS PI12/01434. Dr. Pocovi was supported by FIS PI12/01703. Dr. Hurtado-Roca was supported by FINCyT Science and Technology Program Scholarship Nº088-FINCyT-BDE-2014 from agreement 1663/OC-PE, between the Republic of Peru and the Inter-American Development Bank. Dr. Civeira was supported by FIS PI12/01087 and RETIC RIC RD12/0042/0055; has received personal fees from Sanofi, Lilly, Synageva, Pfizer, and Amgen; and has received grants and personal fees from Merck. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Tasneem Z. Naqvi, MD, served as Guest Editor for this paper.
