Risk factor associations with the presence of a lipid core in carotid plaque of asymptomatic individuals using high-resolution MRI

The Multi-Ethnic Study of Atherosclerosis (MESA)

Bruce A Wasserman, A. Richey Sharrett, Shenghan Lai, Antoinette S. Gomes, Mary Cushman, Aaron R. Folsom, Diane E. Bild, Richard A. Kronmal, Shantanu Sinha, David A. Bluemke

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE - Atheroma vulnerability to rupture is increased in the presence of a large lipid core. Factors associated with a lipid core in the general population have not been studied. METHODS - The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of individuals free of clinical cardiovascular disease designed to include a high proportion of ethnic minorities. We selected MESA participants from the top 15th percentile of maximum carotid intima media thickness by ultrasound and acquired high-resolution black blood MRI images through their carotid plaque before and after the intravenous administration of gadodiamide (0.1 mmol/kg). Lumen and outer wall contours were defined using semiautomated analysis software. We analyzed only plaques with a maximum thickness ≥1.5 mm by MRI (n=214) and assessed cross-sectional risk factor associations with lipid core presence by multivariable logistic regression. RESULTS - A lipid core was present in 151 (71%) of the plaques. After controlling for age, ethnicity, sex, maximum arterial wall thickness, hypertension, cigarette smoking, diabetes, and C-reactive protein, compared with participants in the lowest tertile of total plasma cholesterol, the ORs of having a lipid core for participants in the middle and highest tertiles were 2.76 (95% CI: 1.01 to 7.51) and 4.63 (95% CI: 1.56 to 13.75), respectively. None of the other risk factors was associated with lipid core. CONCLUSIONS - In persons with thickened carotid walls, plasma total cholesterol, but not other established coronary heart disease risk factors, is strongly associated with lipid core presence by MRI. High total cholesterol may be associated with rupture proneness of atherosclerotic lesions in the general population.

Original languageEnglish (US)
Pages (from-to)329-335
Number of pages7
JournalStroke
Volume39
Issue number2
DOIs
StatePublished - Feb 2008

Fingerprint

Atherosclerosis
Lipids
gadodiamide
Cholesterol
Rupture
Carotid Intima-Media Thickness
Atherosclerotic Plaques
Intravenous Administration
C-Reactive Protein
Population
Multicenter Studies
Coronary Disease
Cohort Studies
Cardiovascular Diseases
Software
Logistic Models
Smoking
Hypertension

Keywords

  • Atherosclerosis
  • Carotid artery
  • Cholesterol
  • Lipid core
  • Magnetic resonance
  • MRI
  • Risk factors
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)
  • Medicine(all)

Cite this

Risk factor associations with the presence of a lipid core in carotid plaque of asymptomatic individuals using high-resolution MRI : The Multi-Ethnic Study of Atherosclerosis (MESA). / Wasserman, Bruce A; Sharrett, A. Richey; Lai, Shenghan; Gomes, Antoinette S.; Cushman, Mary; Folsom, Aaron R.; Bild, Diane E.; Kronmal, Richard A.; Sinha, Shantanu; Bluemke, David A.

In: Stroke, Vol. 39, No. 2, 02.2008, p. 329-335.

Research output: Contribution to journalArticle

Wasserman, Bruce A ; Sharrett, A. Richey ; Lai, Shenghan ; Gomes, Antoinette S. ; Cushman, Mary ; Folsom, Aaron R. ; Bild, Diane E. ; Kronmal, Richard A. ; Sinha, Shantanu ; Bluemke, David A. / Risk factor associations with the presence of a lipid core in carotid plaque of asymptomatic individuals using high-resolution MRI : The Multi-Ethnic Study of Atherosclerosis (MESA). In: Stroke. 2008 ; Vol. 39, No. 2. pp. 329-335.
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abstract = "BACKGROUND AND PURPOSE - Atheroma vulnerability to rupture is increased in the presence of a large lipid core. Factors associated with a lipid core in the general population have not been studied. METHODS - The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of individuals free of clinical cardiovascular disease designed to include a high proportion of ethnic minorities. We selected MESA participants from the top 15th percentile of maximum carotid intima media thickness by ultrasound and acquired high-resolution black blood MRI images through their carotid plaque before and after the intravenous administration of gadodiamide (0.1 mmol/kg). Lumen and outer wall contours were defined using semiautomated analysis software. We analyzed only plaques with a maximum thickness ≥1.5 mm by MRI (n=214) and assessed cross-sectional risk factor associations with lipid core presence by multivariable logistic regression. RESULTS - A lipid core was present in 151 (71{\%}) of the plaques. After controlling for age, ethnicity, sex, maximum arterial wall thickness, hypertension, cigarette smoking, diabetes, and C-reactive protein, compared with participants in the lowest tertile of total plasma cholesterol, the ORs of having a lipid core for participants in the middle and highest tertiles were 2.76 (95{\%} CI: 1.01 to 7.51) and 4.63 (95{\%} CI: 1.56 to 13.75), respectively. None of the other risk factors was associated with lipid core. CONCLUSIONS - In persons with thickened carotid walls, plasma total cholesterol, but not other established coronary heart disease risk factors, is strongly associated with lipid core presence by MRI. High total cholesterol may be associated with rupture proneness of atherosclerotic lesions in the general population.",
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T2 - The Multi-Ethnic Study of Atherosclerosis (MESA)

AU - Wasserman, Bruce A

AU - Sharrett, A. Richey

AU - Lai, Shenghan

AU - Gomes, Antoinette S.

AU - Cushman, Mary

AU - Folsom, Aaron R.

AU - Bild, Diane E.

AU - Kronmal, Richard A.

AU - Sinha, Shantanu

AU - Bluemke, David A.

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N2 - BACKGROUND AND PURPOSE - Atheroma vulnerability to rupture is increased in the presence of a large lipid core. Factors associated with a lipid core in the general population have not been studied. METHODS - The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of individuals free of clinical cardiovascular disease designed to include a high proportion of ethnic minorities. We selected MESA participants from the top 15th percentile of maximum carotid intima media thickness by ultrasound and acquired high-resolution black blood MRI images through their carotid plaque before and after the intravenous administration of gadodiamide (0.1 mmol/kg). Lumen and outer wall contours were defined using semiautomated analysis software. We analyzed only plaques with a maximum thickness ≥1.5 mm by MRI (n=214) and assessed cross-sectional risk factor associations with lipid core presence by multivariable logistic regression. RESULTS - A lipid core was present in 151 (71%) of the plaques. After controlling for age, ethnicity, sex, maximum arterial wall thickness, hypertension, cigarette smoking, diabetes, and C-reactive protein, compared with participants in the lowest tertile of total plasma cholesterol, the ORs of having a lipid core for participants in the middle and highest tertiles were 2.76 (95% CI: 1.01 to 7.51) and 4.63 (95% CI: 1.56 to 13.75), respectively. None of the other risk factors was associated with lipid core. CONCLUSIONS - In persons with thickened carotid walls, plasma total cholesterol, but not other established coronary heart disease risk factors, is strongly associated with lipid core presence by MRI. High total cholesterol may be associated with rupture proneness of atherosclerotic lesions in the general population.

AB - BACKGROUND AND PURPOSE - Atheroma vulnerability to rupture is increased in the presence of a large lipid core. Factors associated with a lipid core in the general population have not been studied. METHODS - The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of individuals free of clinical cardiovascular disease designed to include a high proportion of ethnic minorities. We selected MESA participants from the top 15th percentile of maximum carotid intima media thickness by ultrasound and acquired high-resolution black blood MRI images through their carotid plaque before and after the intravenous administration of gadodiamide (0.1 mmol/kg). Lumen and outer wall contours were defined using semiautomated analysis software. We analyzed only plaques with a maximum thickness ≥1.5 mm by MRI (n=214) and assessed cross-sectional risk factor associations with lipid core presence by multivariable logistic regression. RESULTS - A lipid core was present in 151 (71%) of the plaques. After controlling for age, ethnicity, sex, maximum arterial wall thickness, hypertension, cigarette smoking, diabetes, and C-reactive protein, compared with participants in the lowest tertile of total plasma cholesterol, the ORs of having a lipid core for participants in the middle and highest tertiles were 2.76 (95% CI: 1.01 to 7.51) and 4.63 (95% CI: 1.56 to 13.75), respectively. None of the other risk factors was associated with lipid core. CONCLUSIONS - In persons with thickened carotid walls, plasma total cholesterol, but not other established coronary heart disease risk factors, is strongly associated with lipid core presence by MRI. High total cholesterol may be associated with rupture proneness of atherosclerotic lesions in the general population.

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KW - Carotid artery

KW - Cholesterol

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KW - Magnetic resonance

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KW - Risk factors

KW - Stroke

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