HTML
-
The general characteristics of the study population according to plaque compositions are presented in Table 1. Nearly half of the overall study population (48.6%) have no coronary plaques, 36.6% have noncalcified plaques, and 14.8% have calcified or mixed plaques. The levels of BMI, systolic and diastolic BP, TC, LDL-C, fasting and 2-h post-load glucose, and HbA1c had a significantly increasing trend across groups of participants without plaques, with noncalcified plaques, and with calcified or mixed plaques (all P values for trend < 0.05), whereas percentages of individuals with a family CAD history, education above high school level, currently smoking, currently drinking, or with dyslipidemia were not significantly different.
Characteristics Overall (n = 549) No Plaques (n = 267) Noncalcified Plaques (n = 201) Calcified or Mixed Plaques (n = 81) P for Trend Age (years) 52.2 ± 4.2 51.4 ± 4.4 52.5 ± 4.1* 53.8 ± 3.4§ < 0.001 Men, n (%) 233 (42.4) 92 (34.5) 100 (49.8)† 41 (50.6)* 0.001 Family history of CAD, n (%) 108 (19.7) 50 (18.7) 41 (20.4) 17 (21.0) 0.339 Education above high school level, n (%) 188 (34.2) 99 (36.9) 73 (36.3) 16 (19.8)* 0.098 Current smokers, n (%) 158 (28.8) 62 (23.2) 66 (32.8) 30 (37.0) 0.487 Current drinkers, n (%) 134 (24.7) 53 (20.1) 57 (32.2) 24 (29.6) 0.329 Physical activity (METs-h/week) 31.3 (11.6-69.3) 28.0 (17.6-59.4) 34.7 (11.6-79.1) 34.7 (13.2-69.3) 0.287 BMI (kg/m2) 25.5 ± 3.4 24.9 ± 3.4 26.2 ± 3.3§ 25.7 ± 3.8* 0.002 Systolic BP (mmHg) 132 ± 19 127 ± 17 135 ± 20§ 139 ± 20§ < 0.001 Diastolic BP (mmHg) 80 ± 10 77 ± 9 82 ± 10§ 83 ± 11§ < 0.001 Total cholesterol (mg/dL) 199 ± 36 196 ± 36 202 ± 37* 202 ± 36 0.017 LDL-C (mg/dL) 92 ± 27 90 ± 25 94 ± 28* 95 ± 29 0.042 HDL-C (mg/dL) 52 ± 12 53 ± 12 51 ± 11 53 ± 12 0.208 Triglycerides (mg/dL) 113 (77-172) 105 (72-156) 120 (89-183)* 124 (82-172) 0.063 Fasting PG (mg/dL) 94 (86-105) 92 (85-103) 94 (86-105) 97 (86-121)‡ < 0.001 2-h post-load PG (mg/dL) 144 (112-186) 141 (106-177) 149 (119-184) 141 (110-223) 0.041 HbA1c (%) 6.00 (5.70-6.50) 6.00 (5.70-6.40) 6.00 (5.70-6.50) 6.20 (5.80-6.90)§ < 0.001 HOMA-IR 1.72 (1.04-2.63) 1.58 (0.95-2.41) 1.81 (1.22-2.77)† 1.95 (1.30-2.94) 0.015 Hypertension, n (%) 245 (44.6) 90 (33.6) 110 (54.7)§ 45 (55.6)† < 0.001 Diabetes, n (%) 130 (23.7) 57 (21.3) 43 (21.4) 30 (37.0)† 0.035 Dyslipidemia, n (%) 190 (34.6) 82 (30.6) 76 (27.8) 32 (39.5) 0.151 Note. All comparisons were adjusted for age and sex. Continuous variables are presented as means ± standard deviations or medians (interquartile ranges), and categorical variables are presented as absolute numbers (percentages). *P < 0.05 compared with the no plaques group. †P < 0.01 compared with the no plaques group. ‡ P < 0.001 compared with the no plaques group. §P < 0.0001 compared with the no plaques group. CAD, coronary artery disease; METs, metabolic equivalents; BMI, body mass index; BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; PG, plasma glucose; HbA1c, hemoglobin A1c; HOMA-IR, the index of homeostasis model assessment of insulin resistance. Table 1. General Characteristics of the Study Population
The medians of the FRS were 4.91%, 6.62%, and 7.60%, and the medians of the 10-year ASCVD score were 2.76%, 4.75%, and 5.90% in participants without plaques, with noncalcified plaques, and with calcified or mixed plaques, respectively (both P values for trend < 0.001; Figure 2A and C). Using the FRS and ASCVD score above medians of the overall study population to define high-risk participants, that is, participants with the FRS ≥ 5.60% or participants with the ASCVD score ≥ 3.82%, respectively, percentages of high-risk participants also increased substantially across three groups (both P values for trend < 0.01; Figure 2B and D).
Figure 2. (A) and (C): Levels of the Framingham risk score and the 10-year ASCVD risk score (medians and interquartile ranges). (B) and (D): Percentages of high-risk participants among groups. Group 1, no plaques; Group 2, noncalcified plaques; Group 3, calcified or mixed plaques. P values were adjusted for age and sex. CHD, coronary heart disease; ASCVD, atherosclerotic cardiovascular disease.
Using participants without plaques as the reference, both noncalcified plaques and calcified or mixed plaques were associated with increased FRS levels and an elevated likelihood of having FRS ≥ 5.60% (Table 2). After adjustment for conventional CVD risk factors, participants with noncalcified plaques had a 95% increase [odds ratio (OR) 1.95; 95% confidence interval (CI) 1.26-3.01] and participants with calcified or mixed plaques had a 108% increase (OR 2.08; 95% CI 1.13-3.82) in the likelihood of having elevated FRS compared with participants without plaques. Similar findings were observed for CV risks evaluated by the 10-year ASCVD score (Table 3). After adjustment for conventional CVD risk factors, participants with calcified or mixed plaques had a 141% increase (OR 2.41; 95% CI 1.09-5.32) in the likelihood of having elevated ASCVD score compared with participants without plaques. However, although noncalcified plaques were positively associated with ASCVD score in linear regression models, they were not significantly associated with an increased likelihood of having elevated ASCVD score in logistic regression models after adjustment. Furthermore, associations were generally consistent, and no significant interactions were found between subgroups (Figure 3, all P values for interaction > 0.05).
Models Log-transformed Framingham Risk Score Elevated Framingham Risk Score β ± SE P value OR (95% CI) P value Model 1 No plaques 0.000 (reference) 1.00 (reference) Noncalcified plaques 0.140 ± 0.028 < 0.0001 2.61 (1.79-3.80) < 0.0001 Calcified or mixed plaques 0.218 ± 0.037 < 0.0001 3.06 (1.82-5.15) < 0.0001 Model 2 No plaques 0.000 (reference) 1.00 (reference) Noncalcified plaques 0.087 ± 0.024 0.0003 2.23 (1.48-3.35) 0.0001 Calcified or mixed plaques 0.136 ± 0.033 < 0.0001 2.25 (1.28-3.95) 0.0048 Model 3 No plaques 0.000 (reference) 1.00 (reference) Noncalcified plaques 0.055 ± 0.023 0.0173 1.95 (1.26-3.01) 0.0028 Calcified or mixed plaques 0.112 ± 0.031 0.0003 2.08 (1.13-3.82) 0.0183 Note. Linear regression models were used with the log-transformed Framingham risk score as the dependent variable. Logistic regression models were used with the Framingham risk score ≥ 5.60% as the dependent variable. Model 1: unadjusted. Model 2: adjusted for age and sex. Model 3: adjusted for age, sex, education above high school level, current drinking, physical activity level, overweight or obesity, increased low-density lipoprotein cholesterol, increased triglycerides, and insulin resistance. SE, standard error; OR, odds ratio; CI, confidence interval. Table 2. Associations between Plaque Status and the 10-year Coronary Heart Disease Risk
Models Log-transformed 10-year ASCVD Risk Score Elevated 10-year ASCVD Risk Score β ± SE P value OR (95% CI) P value Model 1 No plaques 0.000 (reference) 1.00 (reference) Noncalcified plaques 0.216 ± 0.041 < 0.0001 2.10 (1.45 -3.04) < 0.0001 Calcified or mixed plaques 0.335 ± 0.056 < 0.0001 3.32 (1.96-5.62) < 0.0001 Model 2 No plaques 0.000 (reference) 1.00 (reference) Noncalcified plaques 0.095 ± 0.026 0.0004 1.61 (0.97-2.69) 0.0682 Calcified or mixed plaques 0.168 ± 0.036 < 0.0001 2.78 (1.38-5.56) 0.0042 Model 3 No plaques 0.000 (reference) 1.00 (reference) Noncalcified plaques 0.050 ± 0.024 0.0399 1.25 (0.71-2.21) 0.4345 Calcified or mixed plaques 0.125 ± 0.033 0.0001 2.41 (1.09-5.32) 0.0300 Note. Linear regression models were used with the log-transformed 10-year ASCVD risk score as the dependent variable. Logistic regression models were used with the 10-year ASCVD risk score ≥ 3.82% as the dependent variable. Model 1: unadjusted. Model 2: adjusted for age and sex. Model 3: adjusted for age, sex, education above high school level, current drinking, physical activity level, overweight or obesity, elevated diastolic blood pressure, increased low-density lipoprotein cholesterol, increased triglycerides, and insulin resistance. ASCVD, atherosclerotic cardiovascular disease; SE, standard error; OR, odds ratio; CI, confidence interval. Table 3. Associations between Plaque Status and the 10-year ASCVD Risk
Figure 3. The likelihood of (A) elevated Framingham risk score and (B) elevated 10-year atherosclerotic cardiovascular disease (ASCVD) risk score in association with plaque composition in the overall population and in subgroups. (A) Logistic regression models were adjusted for age, sex, education above high school level, current drinking, physical activity level, overweight or obesity, increased low-density lipoprotein cholesterol (LDL-C), increased triglycerides, and insulin resistance. (B) Logistic regression models were adjusted for age, sex, education above high school level, current drinking, physical activity level, overweight or obesity, elevated diastolic blood pressure, increased LDL-C, increased triglycerides, and insulin resistance. Lines with a point indicate odds ratios (95% CIs) of noncalcified plaques vs. no plaques. Lines with a triangle indicate odds ratios (95% CIs) of calcified or mixed plaques vs. no plaques. BMI, body mass index; OR, odds ratio; CI, confidence interval.