Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. Stroke 2002; 33:2916–2922. 24 Greenland S. The need for reorientation toward cost-effective prediction: comments on evaluating the added predictive ability of a new mark

• Main Authors: J. David Spence, Md Michael Eliasziw, Phd Maria Dicicco, Rvt Daniel, G. Hackam, Ramzy Galil, Tara Lohmann
• Other Authors: The Pennsylvania State University CiteSeerX Archives
• Format: Text
• Language: English
• Subjects: Greenland
• Online Access: http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.604.6385; http://www.kardiolab.ch/Spence_CarotidPlaqueArea.pdf

Background and Purpose—Carotid plaque area measured by ultrasound (cross-sectional area of longitudinal views of all plaques seen) was studied as a way of identifying patients at increased risk of stroke, myocardial infarction, and vascular death. Methods—Patients from an atherosclerosis prevention clinic were followed up annually for up to 5 years (mean, 2.51.3 years) with baseline and follow-up measurements recorded. Plaque area progression (or regression) was defined as an increase (or decrease) of 0.05 cm2 from baseline. Results—Carotid plaque areas from 1686 patients were categorized into 4 quartile ranges: 0.00 to 0.11 cm2 (n422), 0.12 to 0.45 cm2 (n424), 0.46 to 1.18 cm2 (n421), and 1.19 to 6.73 cm2 (n419). The combined 5-year risk of stroke, myocardial infarction, and vascular death increased by quartile of plaque area: 5.6%, 10.7%, 13.9%, and 19.5%, respectively (P0.001) after adjustment for all baseline patient characteristics. A total of 1085 patients had 1 annual carotid plaque area measurements: 685 (63.1%) had carotid plaque progression, 306 (28.2%) had plaque regression, and 176 (16.2%) had no change in carotid plaque area over the period of follow-up. The 5-year adjusted risk of combined outcome was 9.4%, 7.6%, and 15.7 % for patients with carotid plaque area regression, no change, and progression, respectively (P0.003). Conclusions—Carotid plaque area and progression of plaque identified high-risk patients. Plaque measurement may be