Femoral and carotid subclinical atherosclerosis association with risk factors and coronary calcium: the AWHS study

Authors: LACLAUSTRTA, MARTIN - National Center For Cardiovascular Research(CNIC); CASASNOVAS, JOSE - Instituto Aragone' S De Ciencias De La Salud; FERNANDES-ORTIZ, ANTONIO - National Center For Cardiovascular Research(CNIC); FUSTER, VALENTIN - Mount Sinai School Of Medicine; LEON-LATRE, MONTSERRAT - Instituto Aragone' S De Ciencias De La Salud; JIMENEZ BORREGUERO, LUIS - National Center For Cardiovascular Research(CNIC); POCOVI, MIGUEL - Instituto Aragone' S De Ciencias De La Salud; HURTADO-ROCA, YAMILEE - National Center For Cardiovascular Research(CNIC); ORDOVAS, JOSE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; JARAUTA, ESTIBALIZ - Instituto Aragone' S De Ciencias De La Salud; GUALLAR, ELISEO - Johns Hopkins University; IBANEZ, BORJA - National Center For Cardiovascular Research(CNIC); CIVEIRA, FERNANDO - Instituto Aragone' S De Ciencias De La Salud

Submitted to: Journal of the American College of Cardiology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/27/2015
Publication Date: 3/22/2016
Citation: Laclaustrta, M., Casasnovas, J.A., Fernandes-Ortiz, A., Fuster, V., Leon-Latre, M., Jimenez Borreguero, L.J., Pocovi, M.M., Hurtado-Roca, Y., Ordovas, J.M., Jarauta, E., Guallar, E., Ibanez, B., Civeira, F. 2016. Femoral and carotid subclinical atherosclerosis association with risk factors and coronary calcium: the AWHS study. Journal of the American College of Cardiology. doi: 10.1016/j.jacc.2015.12.056.

Interpretive Summary: Atherosclerosis is a silent disease, and the first manifestation may be in the form of a heart attack. Therefore, substantial effort has been put into detecting early subclinical atherosclerosis, and this has been done mainly in carotid arteries. However, the potential value of femoral arteries for improving the predictive capacity of traditional risk factors is an understudied area. This study sought to evaluate the association of subclinical carotid and femoral plaques with risk factors and coronary artery calcium score (CACS) in middle-aged men. 1,423 participants in the AWHS (Aragon Workers' Health Study,) a study designed to assess cardiovascular risk and subclinical atherosclerosis in a cohort of middle-aged men (40 to 59 years of age,) underwent several tests, including carotid and femoral ultrasounds plus coronary computed tomography. Subclinical atherosclerosis was found in 72% of participants. Plaques were most common in femoral arteries (54%,) followed by coronary calcification (38%) and carotid plaques (34%.) Association of atherosclerosis with risk factors (i.e. cholesterol levels) was stronger in femoral arteries than carotid or coronary arteries. In summary, subclinical atherosclerosis was highly prevalent in this middle-aged male cohort. Association with risk factors and positive CACS was stronger in femoral than carotid arteries. Screening for femoral plaques may be an appealing strategy for improving cardiovascular risk scales and predicting coronary disease, thus achieving better prevention.

Technical Abstract: BACKGROUND: Early subclinical atherosclerosis has been mainly researched in carotid arteries. The potential value of femoral arteries for improving the predictive capacity of traditional risk factors is an understudied area. OBJECTIVES: This study sought to evaluate the association of subclinical carotid and femoral plaques with risk factors and coronary artery calcium score (CACS) in middle-aged men. METHODS: Participants (n = 1,423) of the AWHS (Aragon Workers' Health Study), a study designed to assess cardiovascular risk and subclinical atherosclerosis in a cohort of middle-aged men (40 to 59 years of age), underwent carotid and femoral ultrasound plus noncontrast coronary computed tomography. Subclinical atherosclerosis was defined as the presence of any plaque in carotid or femoral arteries and/or CACS >/= 1. Logistic regression models were used to estimate the prevalence of atherosclerosis adjusted for risk factors and age, to evaluate the association of atherosclerosis with risk factors, and to calculate areas under the receiver-operating characteristic curves for the presence of positive CACS. RESULTS: Subclinical atherosclerosis was found in 72% of participants. Plaques were most common in femoral arteries (54%), followed by coronary calcification (38%) and carotid plaques (34%). Association of atherosclerosis with risk factors was stronger in femoral arteries than carotid or coronary arteries. The area under the receiver-operating characteristic curve for prediction of positive CACS increased from 0.665 when considering only risk factors (dyslipidemia, current smoking, hypertension, diabetes, and age) to 0.719 when adding femoral and carotid plaques (p < 0.001). In this model, the femoral odds ratio (2.58) exceeded the carotid odds ratio (1.80) for prediction of positive CACS. CONCLUSIONS: Subclinical atherosclerosis was highly prevalent in this middle-aged male cohort. Association with risk factors and positive CACS was stronger in femoral than carotid arteries. Screening for femoral plaques may be an appealing strategy for improving cardiovascular risk scales and predicting coronary disease.