Predictors for High-Risk Carotid Plaque in Asymptomatic Korean Population

Abstract

Aims. High-risk carotid plaque remains an important risk factor for atherosclerotic cardiovascular disease (ASCVD). We sought to evaluate the characteristics of carotid plaque and to find out the predictors for high-risk carotid plaque in asymptomatic Koreans. Methods. Subjects ( $n=801$ ) without a history of ASCVD from 12 university hospitals in Korea underwent carotid ultrasound. The images were standardized at core laboratory. Morphologic characteristics of plaque were analyzed with laboratory and clinical characteristics. High-risk carotid plaque features included the highest quartile of carotid plaque score (cPS), irregular plaque surface, and hypoechoic and ulcerated plaque. Results. The carotid plaque prevalence was 22.1% (177/801 persons, 293 plaques). The plaque was increased with age ( $p<0.001$ ) and conventional ASCVD risk estimator ( $p<0.001$ ) and the most frequently found in bulb ( $n=190$ , 64.8%). The number of the highest quartile of cPS was 44/177 (24.9%). Irregular plaque was seen in 20.8% out of total plaque (61/293) and was more frequent in the high-risk 10-year ASCVD risk group than in the low-risk group (36.1% vs. 15.8%, $p=0.023$ ). Hypoechoic and ulcerated plaques were seen in 14.3% (42/293) and 2% (6/293), respectively. The independent predictors for high-risk plaque were age ( $\beta =0.052$ , $p<0.001$ ), HbA1c ( $\beta =0.182$ , $p=0.004$ ), male ( $\beta =0.118$ , $p=0.006$ ), hypertension ( $\beta =0.090$ , $p=0.032$ ), and multiple plaques (OR: 4.810 (two plaques) and 8.621 (three plaques), all $p<0.001$ ). Conclusions. This study suggests that high-risk carotid plaque was seen in 12.4% (99/801). The high-risk plaque was associated with diabetes control status reflected by the HbA1c level as well as traditional risk factors in asymptomatic Korean population.