Association Between Triglyceride Glucose Index and Carotid Artery Plaque in Different Glucose Metabolic States in Patients with Coronary Heart Disease — A RCSCD-TCM Study in China

BackgroundThe triglyceride glucose (TyG) index serves as a surrogate indicator of insulin resistance. However, there are limited data on the association between TyG index and carotid artery plaque (CAP) in patients with coronary heart disease (CHD).MethodsA total of 10,535 CHD patients were included in this study. TyG index was divided into quartiles, Q1: TyG index ＜ 8.52, Q2: 8.52 ≤ TyG index ＜ 8.93, Q3: 8.93 ≤ TyG index ≤ 9.40, Q4: TyG index ＞9.40. Logistic regression was used to analyze the relationship between TyG index and CAP in CHD patients, and further analyzed the relationship between TyG index and CAP in different genders, different age groups and different glucose metabolism states. ResultsA baseline analysis of CHD patients divided into four groups according to the quartile of the TyG index showed that there were significant differences in related parameters between the groups. As the TyG index increases, the incidence of CAP increases significantly. After adjustment for multivariate, TyG index levels for Q3 and Q4 correlated with increased OR in CAP, which Q4 has the highest correlation (OR: 1.42; 95% CI: 1.33 -1.53). The correlation between the Tyg index of female (OR:1.38; 95% CI: 1.31-1.45) and CAP was higher than that of male (OR:1.23; 95% CI: 1.16, 1.30). The OR value of middle-aged (≤ 60 years old) patients (OR:1.14; 95% CI: 1.07-1.22) is higher than that of elderly (＞dayu 60 years old) patients (OR:1.07; 95% CI: 1.02-1.13). Under different glucose metabolism states, the TyG index of CHD patients was significantly related to the risk of CAP, and the OR value of diabetes (DM) was the highest (OR: 1.35; 95% CI: 1.26-1.45).ConclusionsThere is a significant correlation between the TyG index and CAP in CHD patients. In addition, the correlation between TyG index and CAP in CHD patients is higher in female than in male, and the correlation in middle-aged and elderly patients is higher than that in elderly patients. Under the condition of DM, the correlation between TyG index and carotid artery plaque in CHD patients is higher.

Carotid Artery Plaque Progression: Proposal of a New Predictive Score and Role of Carotid Intima-Media Thickness

Background: We aimed to investigate if the carotid intima-media thickness (IMT) at baseline and the HAD2S score, composed of the sum of single risk factors (hypertension, age ≥ 75 years, diabetes, dyslipidemia, smoking), were predictive of plaque progression. Methods: We performed a retrospective analysis on real-life prospectively collected data from patients with any detectable carotid plaque at follow up. The plaque score, calculated at baseline (T0) and at a median follow up of 36.6 months (IQR 39.6–34.3) (T3), was defined as 0: no plaque or stenosis < 30%; 1: stenosis in the range 30–49%; 2: in the range 50–69%; 3: in the range 70–99% and 4: occlusion. Carotid IMT was measured at T0 and T3; HAD2S score was calculated at baseline. Results: We included 340 patients with a mean age of 69.9 (9.1) years and 25.3% subjects had plaque progression. Individuals with progression had a median HAD2S score of 3 (1) while those without progression had 2 (1). Patients with progression had a mean baseline IMT of 0.86 (0.17) while those without progression had 0.77 (0.18) (p < 0.0001). A correlation between progression and baseline IMT was found (p = 0.002). Conclusion: Baseline IMT could be considered a predictor of progression. Patients with progression had an HAD2S score higher than those without evolution.

Identification of Symptomatic Carotid Artery Plaque: A Three-Item Scale Combined Angiography With Optical Coherence Tomography

Introduction: Symptomatic carotid disease conveys a high risk of recurrent stroke. Plaque morphology and specific plaque characteristics are associated with the risk of stroke. This study aimed to evaluate the detailed plaque features by optical coherence tomography (OCT) and develop a simple scale combining clinical indicators, digital subtraction angiography (DSA), and OCT imaging markers to identify symptomatic carotid plaque.Methods: Carotid plaques from consecutive patients who underwent carotid OCT imaging between June 2017 and June 2021 were evaluated. Clinical characteristics, DSA, and OCT data were compared between the symptomatic and asymptomatic groups. Logistic regression was performed to identify the factors associated with symptomatic carotid plaque and to develop a scale. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of the scale.Results: A total of 90 carotid plaques from 90 patients were included (symptomatic 35.6%, asymptomatic 64.4%). Three main factors were found to be associated with symptomatic carotid plaque: high-density lipoprotein cholesterol (HDL-C) &lt;0.925 mmol/L (OR, 4.708; 95% CI, 1.640 to 13.517; P = 0.004), irregular plaque (OR, 4.017; 95% CI, 1.250 to 12.910; P = 0.020), and white thrombus (OR, 4.594; 95% CI, 1.141 to 18.487; P = 0.032). The corresponding score of three items produced a scale with good discrimination (AUC, 0.768; 95% CI, 0.665 to 0.871). The optimal cutoff value of the scale was 1.5 points with 59.4% sensitivity and 84.5% specificity.Conclusion: The three-item scale comprising HDL-C &lt;0.925 mmol/L, angiographical irregular plaque, and white thrombus detected by OCT may provide information to identify symptomatic carotid plaque. Further large-scale studies are required to validate whether the symptomatic carotid plaque scale is clinically valuable in recognizing carotid atherosclerosis in the early stages.

Carotid Artery Plaque Calcifications: Lessons From Histopathology to Diagnostic Imaging

The role of calcium in atherosclerosis is controversial and the relationship between vascular calcification and plaque vulnerability is not fully understood. Although calcifications are present in ≈50% to 60% of carotid plaques, their association with cerebrovascular ischemic events remains unclear. In this review, we summarize current understanding of carotid plaque calcification. We outline the role of calcium in atherosclerotic carotid disease by analyzing laboratory studies and histopathologic studies, as well as imaging findings to understand clinical implications of carotid artery calcifications. Differences in mechanism of calcium deposition express themselves into a wide range of calcification phenotypes in carotid plaques. Some patterns, such as rim calcification, are suggestive of plaques with inflammatory activity with leakage of the vasa vasourm and intraplaque hemorrhage. Other patterns such as dense, nodular calcifications may confer greater mechanical stability to the plaque and reduce the risk of embolization for a given degree of plaque size and luminal stenosis. Various distributions and patterns of carotid plaque calcification, often influenced by the underlying systemic pathological condition, have a different role in affecting plaque stability. Modern imaging techniques afford multiple approaches to assess geometry, pattern of distribution, size, and composition of carotid artery calcifications. Future investigations with these novel technologies will further improve our understanding of carotid artery calcification and will play an important role in understanding and minimizing stroke risk in patients with carotid plaques.

Association between the Plasma-Glycosylated Hemoglobin A1c/High-Density Lipoprotein Cholesterol Ratio and Carotid Atherosclerosis: A Retrospective Study

Background. Diabetes mellitus (DM) and dyslipidemia are the main risk factors for atherosclerosis. Elevated glycosylated hemoglobin A1c (HbA1c) and reduced high-density lipoprotein cholesterol (HDL-C) are associated with the progression of atherosclerosis. The aim of this study is at exploring the relationship between the HbA1c/HDL-C ratio and atherosclerosis evaluated using carotid artery intima-media thickness (cIMT) and carotid artery plaque. Methods. In this retrospective study, we enrolled 1304 patients who had multiple cardiovascular risk factors or symptoms of suspected coronary artery disease. cIMT and carotid artery plaque were measured using ultrasonography. Logistic regression was used to explore the correlation between the HbA1c/HDL-C ratio and cIMT or carotid artery plaque. We used restricted cubic spline curves to assess nonlinear relationships between the HbA1c/HDL-C ratio and cIMT or carotid artery plaque. Results. With increased quartiles of HbA1c/HDL-C, patients had higher cIMT and a greater carotid plaque burden. After adjusting for other relevant clinical covariates, patients with the highest HbA1c/HDL-C ratio (quartile 4 (Q4)) had a 2.88 times (95% confidence interval (CI): 2.02–4.10, P < 0.001 ) more abnormal mean cIMT, 3.72 times (95% CI: 2.55–5.44, P < 0.001 ) more abnormal maximum cIMT, and 2.58 times (95% CI: 1.70–3.91, P < 0.001 ) greater carotid artery plaque burden compared with patients who had the lowest HbA1c/HDL-C ratio (Q1). Moreover, the association of HbA1c/HDL-C with atherosclerosis remained significant in a subsample of patients with and without DM. Conclusion. As a novel compound indicator for evaluating blood glucose homeostasis and dyslipidemia, the HbA1c/HDL-C ratio was positively correlated with carotid atherosclerosis evaluated using the mean and maximum cIMT as well as the carotid artery plaque burden.

The Correlation Between Collagen Types and Ultrasound Feature Score in Evaluating the Vulnerability of Carotid Artery Plaque

Objectives: To investigate whether ultrasound score has clinical value in identifying carotid artery-vulnerable plaque and the impacts of collagen distribution on the stability of plaque.Materials and Methods: Standard carotid artery ultrasound examinations were performed in 51 patients with carotid artery plaques before carotid endarterectomy. Hematoxylin-eosin staining and Sirius red–picric acid staining of plaque sections were performed to analyze the pathological features and collagen distribution. All plaques were classified into vulnerable and stable groups by pathological features. Ultrasound scores, cap thickness, and the ratios of different collagen types were recorded and analyzed between two groups and different parts of plaques.Results: Ultrasound scores of the vulnerable group were higher than those of the stable group (4.35 ± 1.23 vs. 2.09 ± 1.04, P = 0.001). AUC was 0.894 (best cutoff point three) in differentiating vulnerable and stable plaques. Compared with the stable group, the fibrous caps of the vulnerable group were thinner (P = 0.012); the area ratios of collagen type I to all collagen in the vulnerable group were lower (P = 0.033); however, the area ratios of collagen type IV to all collagen were higher (P = 0.026). Compared with downstream shoulders, the ultrasound scores of upstream shoulders of plaque were higher (P = 0.001), the fibrous caps of upstream shoulders were thinner (P = 0.001), and the area ratios of collagen type I to all collagen were lower (P = 0.022).Conclusion: Ultrasound score could have a clinical value in identifying vulnerable carotid artery plaque, and the collagen distribution could impact the stability of plaques, especially collagen type I and type IV. The results also prompted that the upstream shoulders were more vulnerable than the downstream shoulders.

CAROTID PLAQUE CHARACTERISTICS AND ITS PREVALENCE IN PATIENTS WITH CORONARY ARTERY DISEASE: AN OBSERVATIONAL STUDY

Background and Aims: To evaluate the prevalence and clinical significance of carotid artery plaque, in patients with coronary artery disease. Material and Methods: A total of 1000 patients with 40-80 years of age with coronary artery disease were enrolled. Carotid ultrasonography was performed in all these patients. Results: Among 100 patients with carotid artery disease, 36 had a carotid plaque. In plaque-positive cases, a majority of patients were in a 50 – 60-year age group. Dyslipidemia was found to be the most common risk factor for carotid plaque. In 36 plaque-positive cases, 20 (56%) were having the plaque at the carotid bulb and 16 (44%) were having the plaque at the common carotid artery. Out of 36 cases, 16 (44%) were hyperechogenic, 8 (22%) were calcified, 6 (17%) were moderate echogenic, 6 (17%) were low echogenic. Conclusion: High-resolution B-mode ultrasonography is a useful non-invasive method to evaluate carotid atherosclerosis. Carotid plaques of the common carotid artery are a surrogate marker of atherosclerosis and associated with cardiovascular events. Routine screening of patients with coronary artery disease may be considered. Keywords: Carotid artery stenosis, coronary artery disease, cardiovascular events, atherosclerosis, carotid ultrasonography.

Transition from metabolically healthy to unhealth status associated with risk of carotid artery plaque in Chinese adults

Objective We aimed to evaluate the association between the shift of metabolic status and future risk of carotid artery plaque (CAP) in community-based Chinese adults. Methods The current study included 9836 Chinese adults (4085 males and 5751 females, mean age 35.8 years) with metabolically healthy status at baseline (2013). Metabolically healthy status was defined as no self-reported history of metabolic diseases and cancer, and normal blood pressure, fasting blood glucose, glycated hemoglobin A1c level, and lipid profiles. Metabolically unhealthy status was defined if any of the following metabolic abnormalities were confirmed twice during follow up: high blood pressure, impaired glucose regulation, high triglycerides, high total cholesterol, high low-density lipoprotein cholesterols, or low high-density lipoprotein cholesterols. The transition was confirmed if participants’ metabolic status shifted from baseline healthy to unhealthy status during follow up (2014–2018). Results We have identified 133 incident cases of CAP during follow up. Compared to those who remained metabolically healthy, the transition to high blood pressure, high total cholesterol, and high low-density lipoprotein cholesterols, were associated with high risk of developing carotid artery plaque (Hazards ratios (HRs) ranged from 1.69 to 2.34; p < 0.05 for all). The transition to impaired glucose regulation, high total triglycerides, and low high-density lipoprotein cholesterols, were associated with high risk of carotid artery plaque only in participants with metabolically healthy overweight at baseline (HR ranged from 1.95 to 4.62; p < 0.05 for all). Conclusion The transition from baseline metabolically healthy status to unhealth status was associated with high risk of incident CAP.