Association Between Traditional Cerebrovascular Risk Factor Burden and Ultrasound‐Based Phenotyping of Carotid Atherosclerotic Plaques
FengJuan Li, Fei Bo, XiuLi JinABSTRACT
Objective
To investigate the association between traditional cerebrovascular risk factor burden and ultrasound‐based carotid plaque phenotyping.
Method
This single‐center cross‐sectional study included 486 patients with carotid plaques detected by ultrasound. Multivariate logistic regression was used to identify factors independently associated with plaque instability, and multiple linear regression was used to examine determinants of plaque maximum thickness and cross‐sectional area.
Results
Among 486 patients, 170 (35.0%) had unstable plaques. In the fully adjusted model, male sex (OR = 1.66, 95% CI: 1.06–2.61, p = 0.028), higher BMI (OR = 1.08, 95% CI: 1.01–1.16, p = 0.022), smoking (OR = 1.72, 95% CI: 1.11–2.70, p = 0.015), alcohol consumption (OR = 1.56, 95% CI: 1.01–2.44, p = 0.044), coronary heart disease (OR = 2.63, 95% CI: 1.56–4.48, p < 0.001), and stenosis severity (moderate: OR = 2.69, 95% CI: 1.64–4.42, p < 0.001; severe: OR = 6.89, 95% CI: 3.03–15.81, p < 0.001) were independently associated with plaque vulnerability. Adding clinical and imaging variables significantly improved model discrimination (AUC: 0.749 vs. 0.787; likelihood ratio test: p = 0.003). The diabetes–hyperlipidemia interaction term was significant (OR = 3.30, 95% CI: 1.24–8.79, p = 0.017), suggesting a synergistic effect. Fasting blood glucose (FBG), analyzed as a continuous variable, was independently associated with greater plaque thickness ( β = 0.08, 95% CI: 0.01–0.15, p = 0.036) and cross‐sectional area ( β = 0.70, 95% CI: 0.25–1.16, p = 0.003). Restricted cubic spline analysis further revealed U‐shaped dose–response relationships between both FBG and LDL‐C with plaque cross‐sectional area (P‐nonlinear = 0.001 for both), with inflection points at approximately 6.6 and 3.0 mmol/L, respectively.
Conclusion
Male sex, higher BMI, smoking, alcohol consumption, coronary heart disease, and stenosis severity were independently associated with carotid plaque instability. Diabetes and hyperlipidemia exhibited a significant synergistic effect. Diabetes was associated with increased plaque volume. These findings suggest that risk assessment should focus on cumulative risk burden rather than isolated indicators.