Atherosclerotic Plaque Found Highly Prevalent in Older Population in China

Yongjun Wang, MD

Atheroscleortic plaque was highly prevalent in older adults in China, with a substantial proportion of individuals reaching stenosis of 50% or greater, according to new findings published in JAMA Network Open.

“This study set the basis for the evaluation of atherosclerosis progression and risk stratification for future vascular events with longitudinal follow-up data,” wrote study author Yongjun Wang, MD, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University and and Tiemin Wei, MD, Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine.

Investigators noted that previous data show subclinical carotid atherosclerosis and coronary artery calcification increased the risk of vascular events. However, there are limited findings on the prevalence, vascular distribution, and burden of polyvascular atherosclerosis in the arterial system with intracranial, coronary, and peripheral vascular territories.

As a result, the current cross-sectional study evaluated the prevalence, vascular distribution, and burden of polyvascular atherosclerosis in a community population based on a baseline survey of the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study.

It enrolled community-dwelling adults who were aged 50 - 75 years based on cluster sampling from 6 villages and 4 living communities of Lushui city in southeast China between May 2017 - September 2019.

The investigators assessed atherosclerotic plaque and stenosis at baseline in multiple vascular territories. It included brain vessel wall magnetic resonance imaging (MRI) for intracranial and extracranial arteries and computer tomography angiography (CTA) for coronary, subclavian, aorta, renal, and iliofemoral arteries. At baseline survey, they performed ankle-brachial index.

Then, the extent of atherosclerosis was assessed according to the number of these 8 vascular sites that were affected, while polyvascular arterosclerotic lesions were defined as ≥2 affected sites in these arteries.

There were a total of 3433 of 4202 invited individuals who consented to participate in the study. Following exclusions, including 366 participants with contraindications for MRI or CTA scanning, a total of 3067 community-dwelling adults were enrolled.

Data show the mean age was 61.2 years, including 1640 (53.5%) women and 74 (2.4%) had prevalent atherosclerotic cardiovascular disease (ASCVD). Most participants (n = 2546; 84.0%) had at least 1 traditional risk factor, while 892 (29.1%) had 2 and 654 (21.3%) had 3 or more risk factors.

Most of the participants (n = 2870 [93.6%]) were found to have atherosclerotic plaque in at least 1 vascular territory. Moreover, atherosclerotic plaques were mostly detected in the aorta (n = 2419 [79.6%]) and iliofemoral arteries (n = 2312 [75.8%]).

This was followed by subclavian (n = 1500 [49.8%]), coronary (n = 1366 [44.9%]), extracranial (n = 1110 [36.4%]), renal (n = 873 [28.7%]), and intracranial (n = 542 [17.7%]) arteries.

Additionally, polyvascular atherosclerotic plaque was observed in 2541 participants (82.8%), with 1436 (46.8%) with plaque affecting 4 or more vascular territories. Polyvascular stenosis was observed in 412 patients (13.4%).

The study, “Prevalence and Vascular Distribution of Multi Territorial Atherosclerosis Among Community-Dwelling Adults in Southeast China,” was published in JAMA Network Open.