Physicians' Academy for Cardiovascular Education

Arterial stiffness is associated with presence and composition of carotid atherosclerotic plaques

Literature - Selwaness M et al. Arterioscler Thromb Vasc Biol. 2014 - Arterioscler Thromb Vasc Biol. 2014 Jan 30


Arterial Stiffness Is Associated With Carotid Intraplaque Hemorrhage in the General Population: The Rotterdam Study

Selwaness M, van Den Bouwhuijsen Q, Mattace-Raso FU, et al.
Arterioscler Thromb Vasc Biol. 2014 Jan 30


Carotid atherosclerotic plaques that contain a large necrotic core, intraplaque haemorrhage (IPH) or thin fibrous cap, are considered vulnerable plaques, which have been associated to increased risk of CV events.
Aortic pulse wave velocity (PWV) is a measure of arterial stiffness that has been shown to be an independent risk factor for stroke and CV mortality [4-6]. It is as yet unknown whether a gradual stiffening of the arterial wall may accelerate development of vulnerable plaque components, such as IPH. The authors have previously shown that a single, cross-sectional measurement of the pulsatile component of blood pressure was associated with IPH [7]. Since arterial stiffness importantly affects systolic blood pressure and pulsatility of flow, PWV may reflect the cumulative damage on the arterial wall.
This study aimed to better understand the pathogenesis of vulnerable plaques, by studying the role of vascular wall properties in the context of atherosclerosis formation. Arterial stiffness was assessed by PWV and carotid plaque components were examined using both ultrasound and MRI imaging. Carotid ultrasonography was done in 6527 subjects (67.0+8.6 years old), 2527 (39.6%) of whom had >1 carotid plaques of >2.5 mm. MRI scanning was done in 1059 subjects.

Main results

  • In all statistical models, higher quartiles of PWV were associated with the presence of plaque, when compared to the lowest quartile. In a model that also adjusted for pulse pressure, the respective odd ratios were 1.18 (95%CI: 1.01-1.37), 1.41 (95%CI: 1.19-1.66) and 1.27 (95%CI: 1.05-1.54). In the full model, PWV did not show a statistically significant linear trend with presence of plaque (OR: 1.06, 95%CI: 0.99-1.14).
  • 1979 carotid arteries were imaged with MRI. IPH was seen in 520 (26.3%), lipid in 552 (27.9%) and calcifications in 1444 (73%) of carotid plaques.
  • PWV was significantly associated with presence of IPH (adj OR per SD increase in PWV: 1.20, 95%CI: 1.04-1.38), while adjusted associations between PWV and lipid or calcifications did not reach statistical significance.


This large population-based cohort study suggests that arterial stiffness is associated with presence and composition of carotid atherosclerotic plaques in the general population. Aortic PWV was independently associated with presence of plaques in the carotid arteries. Among individuals with carotid plaques, arterial stiffness was an important determinant of IPH, independently of plaque size, pulse pressure and other CV risk factors. Arterial stiffness was differently associated with different plaque components, suggesting involvement of vascular wall properties in the formation of the various plaque components. These findings thus add to our understanding of the development of vulnerable atherosclerotic plaques.
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