Author + information
- Tatjana Rundek, MD, PhD⁎ ( and )
- J. David Spence, MD
- ↵⁎Department of Neurology, Miller School of Medicine, University of Miami, Clinical Research Building, Suite #1348, 1120 Northwest 14th Street, Miami, Florida 33136
In their excellent paper, Sillesen et al. (1) omitted mention of the original work on measurement of carotid plaque burden. Spence et al. (2) first measured carotid total plaque area (TPA) in 1990, and developed it for patient management and genetic research, and 3-dimensional methods for evaluation of new therapies. They showed that TPA and progression of TPA strongly predicted the 5-year risk of stroke, death, or myocardial infarction after adjusting for coronary risk factors.
Sillesen et al. (1) stated that the prevalence of plaque they observed (78%) was 2-fold higher than previously reported. However, in the NOMAS (Northern Manhattan Study) study, a population-based study of individuals free of stroke at similar ages, plaque prevalence was 58% on 2-dimensional ultrasound imaging and it was greater by age and among certain race-ethnic groups (3). Prevalence of plaque depends on age and how it is defined. If defined as a focal thickening >1 mm, in vascular patients it increases from 75% of patients at age 35 to 45 years to 99% by age 65 to 75 years, and 100% over age 75 years (2).
Besides plaque burden, other ultrasonographic characteristics of plaque morphology such as plaque surface irregularity, ulceration, texture, and plaque density may be even more important predictors of stroke and cardiovascular disease.
The Tromsø study showed that TPA was a stronger predictor of myocardial infarction and stroke (4) than intima-media thickness, and this was confirmed in a meta-analysis (5). Three-dimensional plaque volume is highly correlated with TPA, and is much more sensitive to change with therapy than intima-media thickness or TPA, so it is the best way to assess effects of new therapies (2). There is little doubt that carotid plaque burden will be a stronger predictor of cardiovascular events in the High Risk Plaque Bioimaging Study than any of the other imaging modalities measured, with the possible exception of coronary calcium.
Please note: Dr. Spence holds an interest in Vascularis.com.
- American College of Cardiology Foundation
- Sillesen H.,
- Muntendam P.,
- Adourian A.,
- et al.
- Mathiesen E.B.,
- Johnsen S.H.,
- Wilsgaard T.,
- Bonaa K.H.,
- Lochen M.L.,
- Njolstad I.