Tattersall Matthew C, Hansen Spencer L, McClelland Robyn L, Korcarz Claudia E, Hansen Kristin M, Post Wendy S, Shapiro Michael D, Stein James H
Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison.
Department of Biostatistics, University of Washington, Seattle.
JAMA Cardiol. 2025 May 1;10(5):487-491. doi: 10.1001/jamacardio.2024.5702.
Carotid artery plaque (CAP) is commonly encountered in clinical practice. Presence of CAP predicts future atherosclerotic cardiovascular disease (ASCVD) events; however, CAP prevalence increases with age, and it is unknown how age and sex affect the association of CAP presence and ASCVD risk.
To describe CAP prevalence by age, sex, race, and ethnicity in a multiethnic population and to investigate whether the impact of CAP detection on relative ASCVD risk declines with age and differs by sex.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study examines participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Adults aged 45 to 84 years who were free of clinical ASCVD at recruitment (2000-2002) were included, and follow-up for ASCVD events was conducted through December 2019. Data analysis was performed from July 2023 to April 2024.
Presence of CAP.
The primary outcome was ASCVD events (coronary heart disease events, stroke, and ASCVD death). Prevalence of CAP by age, sex, race, and ethnicity was calculated. Cox proportional hazards models with age interaction terms were used to investigate associations of CAP and incident ASCVD events across sexes.
Among 6814 adults in the MESA cohort, 5689 participants had complete data and were included in this analysis. Among these 5689 participants, mean (SD) age was 62.0 (10.2) years, and 3002 participants (53%) were female. The cohort included 1551 Black participants (27%), 687 Chinese participants (12%), 1276 Hispanic participants (22%), and 2165 White participants (38%). In total, participants experienced 1043 ASCVD events over a median (IQR) period of 17.6 (10.5-18.4) years. Prevalence of CAP differed by age, sex, race, and ethnicity, ranging from 15% in Chinese women younger than 50 years to 95% in non-Hispanic White men aged 80 to 84 years. CAP independently predicted ASCVD events (hazard ratio, 1.38; 95% CI, 1.20-1.58; P < .001). The strength of this association was stronger among younger participants (≤60 years) vs older (>60 years) (P for interaction = .01), especially among women (P for interaction = .005) vs men (P for interaction = .66). CAP detection in younger individuals conferred higher relative ASCVD risk than in older participants, who had higher absolute risk regardless of CAP.
CAP becomes very common with increasing age among individuals without clinical ASCVD, and the association of CAP with incident ASCVD events was strongest in younger ages, especially among women. These data can help guide ASCVD risk assessment in younger adults and provide perspective when CAP is detected on clinical imaging studies in older adults.
颈动脉斑块（CAP）在临床实践中很常见。CAP的存在预示着未来动脉粥样硬化性心血管疾病（ASCVD）事件；然而，CAP患病率随年龄增长而增加，年龄和性别如何影响CAP存在与ASCVD风险之间的关联尚不清楚。
描述多民族人群中按年龄、性别、种族和族裔划分的CAP患病率，并调查CAP检测对相对ASCVD风险的影响是否随年龄下降以及是否因性别而异。
设计、设置和参与者：这项队列研究考察了动脉粥样硬化多民族研究（MESA）中的参与者。纳入了招募时（2000 - 2002年）无临床ASCVD的45至84岁成年人，并对ASCVD事件进行随访至2019年12月。数据分析于2023年7月至2024年4月进行。
存在CAP。
主要结局是ASCVD事件（冠心病事件、中风和ASCVD死亡）。计算按年龄、性别、种族和族裔划分的CAP患病率。使用带有年龄交互项的Cox比例风险模型来研究CAP与各性别中ASCVD事件发生之间的关联。
在MESA队列的6814名成年人中，5689名参与者有完整数据并纳入本分析。在这5689名参与者中，平均（标准差）年龄为62.0（10.2）岁，3002名参与者（53%）为女性。该队列包括1551名黑人参与者（27%）、687名中国参与者（12%）、1276名西班牙裔参与者（22%）和2165名白人参与者（38%）。在中位数（四分位间距）为17.6（10.5 - 18.4）年的时间里，参与者共经历了1043次ASCVD事件。CAP患病率因年龄、性别、种族和族裔而异，从50岁以下中国女性的15%到80至84岁非西班牙裔白人男性的95%不等。CAP独立预测ASCVD事件（风险比，1.38；95%置信区间，1.20 - 1.58；P <.001）。这种关联在较年轻参与者（≤60岁）中比在较年长参与者（>60岁）中更强（交互作用P = 0.01），尤其是在女性中（交互作用P = 0.005）相比男性（交互作用P = 0.66）。与年长参与者相比，在较年轻个体中检测到CAP会带来更高的相对ASCVD风险，而年长参与者无论是否有CAP都有更高的绝对风险。
在无临床ASCVD的个体中，CAP随着年龄增长变得非常常见，并且CAP与ASCVD事件发生之间的关联在较年轻年龄组中最强，尤其是在女性中。这些数据有助于指导年轻成年人的ASCVD风险评估，并在老年成年人的临床影像研究中检测到CAP时提供参考。
