| Objectives1.To analyze the current status and progress in the research of carotid atherosclerosis,understanding the characteristics and trends of carotid atherosclerosis research.2.To investigate the epidemiological characteristics and related risk factors of carotid atherosclerosis,including increased intima-media thickness(IMT),plaque and stenosis in people aged 40 years and over in China.3.To evaluate the association between carotid atherosclerosis and cardiovascular disease in the Chinese population and explore the significance of ultrasound detection of atherosclerosis in the prevention and treatment of cardiovascular disease(CVD).MethodsThe research literature was from the web of science database,a total of 34,012 English documents were included and 431,387 cited references were identifiable.The CiteSpace software was used to visualize the literature of carotid atherosclerosis.The data of this study were from National Health and Family Planning Commission's screening project “Screening and Intervention Projects for Stroke High-risk Populations” from 2014 to 2015.This project used two-stage stratified cluster sampling method in 31 provinces(except Tibet),and 207 districts/counties were selected.All residents aged ? 40 years were surveyed during the primary screening.Questionnaire surveys,physical examinations,laboratory tests,and carotid ultrasound examinations were conducted in the urban and rural communities.A total of 726,451 people completed the screening,of whom 107095 were examined by carotid ultrasound.177 people who had undergone carotid stenting and endarterectomy were excluded,and eventually 106,918 people were included in the analysis.The complex sampling survey data analysis based on sampling design was used to estimate the prevalence of carotid and related risk factors,including carotid IMT,plaque,and stenosis.The statistical analysis used Surveyfreq and Surveylogistic procedure in SAS 9.2 software.The association between carotid atherosclerosis and CVD was investigated using logistic regression,and Structural Equation Modeling(SEM)based on Mplus software.Results:1.Bibliometric analysis.The number of documents and centrality in the European and American countries in this field is relatively high.The number of research outputs in China has increased rapidly in recent years,but the centrality is relatively low.The studies on carotid atherosclerosis could be divided into two main lines: "clinical symptoms and treatment" and "pathogenesis and prevention",and the development of measurement techniques were interwoven with these two main lines.Medical imaging is an important nodal discipline in this field.Comprehensive application of ultrasonic examination of carotid IMT,plaque and stenosis will improve the CVD risk prediction model in future studies.2.General characteristics of the study population.A total of 106,918 subjects were included in the analyses,46.40% were men,and 48.26% were living in urban areas.The mean age was 61.5±10.2 years.The percentage of people in the eastern,central,and western regions was 45.66%,30.49%,and 23.85%,respectively.3.Prevalence of carotid atherosclerosis and its influencing factors.The weighted and adjusted prevalence of carotid atherosclerosis was 28.8%,which was higher in men than women(30.6% vs 27.2%).It increased with age from 10.3% among adults aged 40-49 years to 52.8% among adults aged ? 70 years,and participants living in urban areas had a higher prevalence than those in rural areas(30.0% vs 27.8%).The prevalence was highest in the eastern regions(37.9%),followed by the central regions(25.7%),and lowest in the western regions(17.4%).The results showed that the prevalence was the highest in stroke patients(63.6%),followed by the high-risk group with ? 3 risk factors(49.9%),and lowest in low-risk group(21.2%).Multivariate logistic regression analysis showed that gender,age,city,regions,smoking,drinking,physical inactivity,obesity,hypertension,diabetes,and dyslipidemia were significantly associated with carotid atherosclerosis.The risk factors of carotid atherosclerosis were different in men and women,urban and rural areas,eastern,central and western regions,and different stroke risk stratification.4.Characteristics of carotid IMT,plaques and stenosis and its influencing factors.The prevalence of increased IMT was 21.2% overall,5.1% unilateral and 16.1% bilateral.Approximately 20.2% of the participants presented plaques,11.5% single and 8.7% multiple plaques,and 0.5% of participants had carotid stenosis > 50%.We found that 8.1% participants were with increased IMT when without plaques,and 7.2% of participants without increased IMT had single or multiple plaques,and 13.1% presented both increased IMT and plaques.Age,city,regions,alcohol consumption,hypertension,diabetes and dyslipidemia were the common factors influencing increased IMT,plaque and stenosis.5.Multivariable logistic regression analysis of the association between carotid atherosclerosis and CVD.After adjusting for age,gender,smoking,alcohol consumption,physical inactivity,obesity,hypertension,diabetes,and dyslipidemia,carotid atherosclerosis was positively associated with stroke,coronary heart disease,and atrial fibrillation,and the odds ratios(ORs)was 1.99.(95%CI: 1.85 to 2.13),1.71(95%CI: 1.22 to 2.41),and 1.55(95%CI: 1.29 to 1.85),respectively.6.Structural equation model analysis of the association between carotid atherosclerosis and CVD.The adverse lifestyle behaviors(0.053)and chronic diseases(0.409)had a significant positive effect on carotid atherosclerosis.The unhealthy lifestyle behaviors(0.091),chronic diseases(0.826,)and carotid atherosclerosis(0.109)had a significant positive effect on CVD.The indirect effects of adverse lifestyle and chronic disease affecting CVD through carotid atherosclerosis were 0.029 and 0.045,respectively.Conclusions:1.The current researches have experienced four stages from the theoretical exploration,the development of tools,a large amount of research knowledge accumulation,to the knowledge solidification.Imaging techniques such as carotid ultrasound will provide crucial technical support for the deepening and differentiation of carotid atherosclerosis research.Carotid ultrasound has a wide range of irreplaceable application values in the research of atherosclerosis mechanism,CVD prediction,highrisk populations screening,and clinical assessment,etc.2.Nearly 30% of people aged 40 years and over in China have presented carotid atherosclerosis.It is estimated that the number of patients has exceeded 164 million,and half of patients had both increased IMT and plaques.The prevalence of carotid atherosclerosis was higher in the elderly,male,urban and eastern regions in China.Gender,age,city,regions,smoking,drinking,physical inactivity,obesity,hypertension,diabetes and dyslipidemia were significantly associated with carotid atherosclerosis.3.Carotid atherosclerosis is an independent risk factor for CVD,and plays a mediating role between traditional cardiovascular risk factors and CVD.Since carotid atherosclerosis and CVD have common influence factors,early detection of carotid atherosclerosis by ultrasound and management of these risk factors will prevent and delay the occurrence and development of CVD.Carotid ultrasonography has important values in the prevention and treatment of CVD in Chinese population. |
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