| Part one:The Association between Carotid Atherosclerosis and Cardiovascular DiseaseObjectiveTo access the effect of carotid atherosclerosis(CAS)on the development of cardiovascular diseases(CVDs)in a community-based population aged 55 years and over.MethodsIn July to Sepember,2009 survery of Beijing Longitudinal Study of Aging(BLSA),a total of 2468 residents aged 55 years and over were enrolled in urban and rural areas of Beijing.Each participant was asked to complete the baseline assessment,which consisted of answering a questionnaire and undergoing a physical examination,taking a fasting blood sample,and a carotid ultrasonography examination.In December 2014,a follow-up survey was performed to collect all-cause deaths and new CVD events which including stroke,acute myocardial infarction(AMI),sudden cardiac death,coronary bypass surgery,and coronary angioplasty.Of 2468 participants,1421 participants completed both carotid ultrasonography examination and laboratory assessment.Of 1421 participant,1376 were free of history of myocardial infarction or stroke within the past 1 year.We defined the severity of CAS in combination with several CAS indicators,i.e.common carotid artery intima–media thickness(CCA-IMT),plaques,and stenosis.Non-CAS: CCA-IMT<1 mm and no plaques,minimal CAS: CCA-IMT?1 mm and no plaque,non-stenotic plaques:(carotid stenosis <50%,stenotic plaques: carotid stenosis ?50%.Cox proportional hazard model were performed to estimate hazard ratio(HR),as well as 95% confidence interval(CI).The confounders including age,gender,hypertension,diabetes,hyperlipidemia,history of myocardial infarction,history of stroke,BMI,hs CRP,and smoking and drinking status were adjusted.Results1.The average age of 1376 participates was 69.45 ± 8.09 years and 44.9% were male at baseline.The mean CCA-IMT was 1.06 ± 0.17 mm,and 77.5% of the participants were detected to have increased CCA-IMT,plaques or stenosis.The most common presentation of CAS was non-stenotic plaques,which accounted for 61.0%,followed by non-CAS 22.5%,then minimal atherosclerosis 10.5%,and then stenosis plaques 6.0%,respectively.2.The average follow-up time was 5.15±1.17 years,and the follow-up rate was 86.1% in 1376 participates.A total of 179 subjects died and 202 new CVD events occurred.After full adjusted all of the potential confounders,there was no significant difference in the risk of all-cause death among 4 groups with different degree of CAS(all P>0.05).The risks of CVD in participants with non-stenotic plaques,and stenotic plaques were 1.01(HR: 2.01,95% CI: 1.24-3.25),and 2.05(HR: 3.05,95% CI: 1.62-5.74)times greater than those in participants with non-CAS,respectively.3.Subgroup analysis showed that adjusted risks of death and CVD in individuals with plaques was 1.87-fold(HR: 1.87,95% CI: 1.17-2.97)and 2.29-fold(HR: 2.29,95% CI: 1.51-3.48)greater than that in participants without plaques.We analyzed the association of CCA-IMT both as a continuous variable and as a categorical variable classified by either binary or quartiles and the study end point.The results showed that,the risk of CVD events increased by 13%(HR: 1.13,95% CI: 1.02-1.25)with each 0.1-mm increase in CCA-IMT after controlling for all confounders.Compared to participants with a CCA-IMT in the lowest quartile,those with a CCA-IMT in the highest quartile were associated with CVD(HR: 1.77,95% CI: 1.1-2.85)after multivariable adjustment.Conclusion1.The presence of CAS was common in the 55 years and older cohort of Beijing.The most common presentation of CAS was non-stenotic plaques.2.CAS was independently associated with CVD,the risk of CVD increased with the degree of CAS severity.3.The predictive role of carotid plaques on all-cause death and development of CVD were confirmed in our study.The effect of CCA-IMT on future CVD risk was significant and independent.The parameter of CCA-IMT greater than the 75 th percentile might be used as a proper cutoff point for prediction future death and CVD.Part two:The Performance of Predictive Scores to New Stroke events and Added value of Carotid Atherosclerosis in Middle Aged and Elderly Adults of CommunityObjectiveWe compared the performance of predictive scores on first and recurrence stroke prediction and evaluated the improvement in discriminative ability by measures of carotid atherosclerosis(CAS)among the population aged 55 years old and over.MethodsStudy participants were recruited from the Beijing Longitudinal Study of Aging(BLSA).The baseline assessment was completed in 2009.In 2014,a follow-up survey was performed to collect new stroke events.There were 1421 participants completed the baseline assessment including the questionnaire,carotid ultrasonography and laboratory.The new stroke events included fatal stroke and non-fatal stroke.According to the history of TIA(Transient Ischemic Attack)or stroke,we divided the participants with complete data into participants free of TIA/stroke group and participants with prior TIA/stroke group.Predictive abilities for 5-year new stroke event of ASCVD risk in China(China-PAR),Essen Stroke Risk Score(ESRS),and Stroke Prognostic Instrument ?(SPI-?)were accessed using the area under the receiver-operating characteristic curve(AUC).Then,the measures of CAS including carotid stenosis,stability of carotid plaques and CCA-IMT were added to the original predictive scores.The predictive abilities of the modified predictive scores to predict new stroke events were evaluated.Results1.The average age was 69.42 ± 8.09 years and 44.8% were male among the 1421 pariticipants with complete data..Two hounderd and sixty nine pariticipants had history of TIA/stroke,110 of them had a history of TIA and 159 had a history of stroke.With an average of 5.16±1.17 year's follow-up,1225 participants complete the follow-up survey with a follow-up rate of 86.2%.There were 140 new cases of stroke recorded.2.The AUC of China-PAR,ESRS and SPI-? for 5-year risk of stroke were 0.60,0.58,and 0.56,respectively.In the participants free of TIA/stroke,the AUC of China-PAR was the highest among the 3 predictive scores(0.56 for China-PAR,0.55 for ESRS and 0.51 for SPI-II).In pariticipants with prior TIA/stroke,the AUC of China-PAR was also the highest among the 3 predictive scores(0.70 for China-PAR,0.60 for ESRS and 0.62 for SPI-II).3.The measures of CAS could significantly increase the prediction value of the 3 predictive scores on the 5-year risk of stroke.The best improvement was acheved when carotid stenosis was added to the original model/score,followed by the stability of plaques.Adding carotid stenosis to SPI-II and ESRS,the AUCs increased by 16.1%(P=0.002)and 6.9%(P=0.034),respectively.Conclusion1.About 1/5 of participants had the history of TIA/stroke in the adult population of Beijing aged 55 years and over.2.The China-PAR,ESRS,and SPI-II had moderate predictive abilities for 5-year new stroke.The improvement of SPI-II was the highest after combined with carotid stenosis for new stroke.3.China-PAR,ESRS and SPI-? were moderately effective in predicting the first-ever and recurrent stroke events.The improvement of SPI-II was the highest after combined with carotid stenosis for first-ever stroke.China-PAR has the highest predictive value for recurrent stroke in the 3 preditive scores. |
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