Prevalence, Impact, and Predictive Value of Detecting Subclinical Coronary and Carotid Atherosclerosis in Asymptomatic Adults
Open accessAbstract
Background Although recent studies suggest that measuring coronary artery calcification (CAC) may be superior to indirect atherosclerotic markers in predicting cardiac risk, there are limited data evaluating imaging-based biomarkers that directly quantify atherosclerosis in different vascular beds performed in a single cohort.Objectives The BioImage Study (A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population) sought to identify imaging biomarkers that predict near-term (3-year) atherothrombotic events.Methods The BioImage Study enrolled 5,808 asymptomatic U.S. adults (mean age: 69 years, 56.5% female) in a prospective cohort evaluating the role of vascular imaging on cardiovascular risk prediction. All patients were evaluated by CAC and novel 3-dimensional carotid ultrasound. Plaque areas from both carotid arteries were summed as the carotid plaque burden (cPB). The primary endpoint was the composite of major adverse cardiac events (MACE) (cardiovascular death, myocardial infarction, and ischemic stroke). A broader secondary MACE endpoint also included all-cause death, unstable angina, and coronary revascularization.Results Over a median follow-up of 2.7 years, MACE occurred in 216 patients (4.2%), of which 82 (1.5%) were primary events. After adjustment for risk factors, and compared with individuals without any cPB, hazard ratios for MACE were 0.78 (95% confidence interval [CI]: 0.31 to 1.91), 1.45 (95% CI: 0.67 to 3.14), and 2.36 (95% CI: 1.13 to 4.92) with increasing cPB tertile, with similar results for CAC. Net reclassification significantly improved with either cPB (0.23) or CAC (0.25). MACE rates increased simultaneously with higher levels of both cPB and CAC.Conclusions Detection of subclinical carotid or coronary atherosclerosis improves risk predictions and reclassification compared with conventional risk factors, with comparable results for either modality. Cost-effective analyses are warranted to define the optimal roles of these complementary techniques. (BioImage Study: A Clinical Study of Burden of Atherosclerotic Disease in an At-Risk Population; NCT00738725).
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Carotid or femoral plaque burden assessed by ultrasound is predictive of cardiovascular events, comparable to coronary artery calcium.
“Assessment of carotid or femoral plaque burden with ultrasound has also been demonstrated to be predictive of CV events, comparable to CAC [20-23]”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [20]
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- Authors
- Baber, U., Mehran, R., Sartori, S., Schoos, M. M., Sillesen, H., Muntendam, P., Garcia, M. J., Gregson, J., Pocock, S., Falk, E., & Fuster, V.
- Affiliations
- Icahn School of Medicine at Mount Sinai (US)
- Copenhagen University Hospital (DK)
- scPharmaceuticals (United States) (US)
- Montefiore Medical Center (US)
- London School of Hygiene & Tropical Medicine (GB)
- Aarhus University Hospital (DK)
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 65
- Issue
- 11
- Pages
- 1065-1074
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1904745228
- Cited by
- 461
- References
- 46
- Citations by year
- 2026: 28 · 2025: 31 · 2024: 40 · 2023: 40 · 2022: 51 · 2021: 39 · 2020: 52 · 2019: 38 · 2018: 39 · 2017: 41 · 2016: 45 · 2015: 17
- FWCI
- 38.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
- Keywords
- subclinical atherosclerosis, coronary artery calcification, carotid plaque burden, major adverse cardiac events, cardiovascular risk prediction, imaging biomarkers, asymptomatic adults, net reclassification improvement, atherothrombotic events, cost-effectiveness, ischemic stroke, myocardial infarction, cardiovascular mortality
- MeSH terms
- Aged, Aged, 80 and over, Carotid Artery Diseases, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Tomography, X-Ray Computed, Prevalence, Risk Assessment, Imaging, Three-Dimensional, Asymptomatic Diseases, Carotid Intima-Media Thickness, Vascular Calcification
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