Division of Cardiology, Heart Center, Konyang University Hospital, Daejeon, Korea.
Korean Circ J. 2009 Aug;39(8):317-21. doi: 10.4070/kcj.2009.39.8.317. Epub 2009 Aug 27.
Carotid artery intima-media thickness (CIMT) has recently been recommended as a non-invasive tool for primary prevention of cardiovascular events; the association between CIMT and adverse cardiovascular events is well-known. We sought to evaluate the prevalence and significance of carotid artery plaque, especially in patients with coronary atherosclerosis.
The study population consisted of 1,705 consecutive patients {933 males (54.7%); mean age, 59.7+/-10.9 years} who underwent coronary angiography and carotid artery scanning using high-resolution ultrasonography. Carotid plaque was defined as a focal structure encroaching into the arterial lumen by at least 50% of the surrounding IMT value or a thickness >1.2 mm.
Carotid plaque was identified in 30.3% (516/1,705) of the patients. Of patients in whom the plaque location could be evaluated (n=1,027), carotid plaque was located at the common carotid artery {n=64/267 (24.0%)}, carotid bulb {n=194/267 (72.7%)}, and at both sites {n=9/267 (3.4%)}. The prevalence of hypertension (58.5% vs. 45.2%, p<0.001) and diabetes mellitus (30.6% vs. 23.5%, p=0.007) was higher in patients with carotid plaques. The patients with carotid plaques were older (65.4+/-8.9 years vs. 57.2+/-10.7 years, p<0.0001), had a thicker CIMT (0.89+/-0.20 mm vs. 0.77+/-0.16 mm, p<0.001), and higher fasting blood sugar (FBS) levels (132.1+/-60.7 mg/dL vs. 121.6+/-47.1 mg/dL, p<0.001) than those without carotid plaque. Patients with carotid plaque more frequently presented with acute coronary syndrome (32.4% vs. 23.9%, p<0.001) than those without carotid plaque. Significant coronary artery stenosis by coronary angiography (75.4% vs. 58.3%, p<0.001), especially multi-vessel disease (46.3% vs. 27.2%, p<0.001), was more frequent in patients with carotid plaques. On multivariate analysis, old age (>/=65 years), hypertension, and increased CIMT (>/=1.0 mm) were independent predictors of carotid plaque. Carotid plaque (odds ratio, 1.85; 95% confidence interval, 1.39-2.45; p<0.001) was an independent predictor of multivessel disease based on multivariate regression analysis.
Carotid plaque was common (30.3%) in Korean patients with coronary atherosclerosis, but it is still relatively uncommon compared to Western populations. Carotid plaque was associated with old age, hypertension, and increased IMT, and was an independent predictor of multi-vessel disease.
颈动脉内膜中层厚度（CIMT）最近被推荐作为预防心血管事件的一种非侵入性工具；CIMT 与不良心血管事件之间的关联是众所周知的。我们试图评估颈动脉斑块的患病率及其意义，特别是在冠状动脉粥样硬化患者中。
研究人群由 1705 例连续接受冠状动脉造影和颈动脉高分辨率超声扫描的患者组成{933 例男性（54.7%）；平均年龄 59.7+/-10.9 岁}。颈动脉斑块定义为至少有 50%周围 IMT 值或厚度>1.2 毫米的局灶性结构侵入动脉腔。
在 30.3%（516/1705）的患者中发现颈动脉斑块。在能够评估斑块位置的患者中（n=1027），颈动脉斑块位于颈总动脉{64/267（24.0%）}、颈动脉球{194/267（72.7%）}和两个部位{9/267（3.4%）}。颈动脉斑块患者的高血压（58.5% vs. 45.2%，p<0.001）和糖尿病（30.6% vs. 23.5%，p=0.007）患病率更高。颈动脉斑块患者年龄更大（65.4+/-8.9 岁 vs. 57.2+/-10.7 岁，p<0.0001），CIMT 更厚（0.89+/-0.20 毫米 vs. 0.77+/-0.16 毫米，p<0.001），空腹血糖（FBS）水平更高（132.1+/-60.7 毫克/分升 vs. 121.6+/-47.1 毫克/分升，p<0.001）。与无颈动脉斑块的患者相比，颈动脉斑块患者更常出现急性冠状动脉综合征（32.4% vs. 23.9%，p<0.001）。颈动脉斑块患者的冠状动脉狭窄更严重（75.4% vs. 58.3%，p<0.001），特别是多血管疾病（46.3% vs. 27.2%，p<0.001）更为常见。多变量分析显示，年龄（>/=65 岁）、高血压和 CIMT 增加（>/=1.0 毫米）是颈动脉斑块的独立预测因素。颈动脉斑块（比值比，1.85；95%置信区间，1.39-2.45；p<0.001）是多血管疾病的独立预测因素，这是基于多变量回归分析得出的。
在韩国患有冠状动脉粥样硬化的患者中，颈动脉斑块很常见（30.3%），但与西方人群相比仍然相对少见。颈动脉斑块与年龄、高血压和 IMT 增加有关，是多血管疾病的独立预测因素。
