Rate of carotid disease progression in asymptomatic low to moderate risk individuals: the RIGHT study

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Authors

• V Sandfort
• M Ahlman
• S Lai
• M Mallek
• C Sibley
• D Bluemke

Abstract

Purpose: Cardiovascular disease is a leading cause of death in industrialized countries. Advances in imaging enable serial assessment of atherosclerosis. The aim of this study was to examine the feasibility of serial carotid MRI in an asymptomatic population. Methods: Carotid MRI was performed on 106 asymptomatic patients with hyperlipidemia at baseline and after 1 year (RIGHT study, Randomized Trial of Imaging Versus Risk Factor-Based Therapy for Plaque Regression). All patients received statin therapy. The average wall area per slice was measured in the internal carotid artery. The relationship of parameters of progression with clinical risk factors was evaluated using univariate and multivariable analysis. Results: The mean subject age was 65 years (63 % male). The mean Framingham risk was 9% and the mean BMI was 28. The mean carotid area change showed a slight regression (not significantly different from zero). Overall regression occurred in 57 % of the subjects while in 43% progression was noted. In a univariate analysis only obesity was associated with progression. In the majority of obese subjects progression was seen (19 of 28 subjects, 68%) while in the majority of non-obese subjects regression occurred (51 of 78 subjects, 65%). In a multivariate model the only parameters associated with disease progression was obesity. Discussion: Obesity was associated with progression of carotid atherosclerosis. There was no statistical correlation with other factors. Obesity has been shown to cause higher levels of vascular inflammation and has an unfavorable effect on dyslipidemia. Both factors might offer an explanation for our findings.

Scientific Focus Area: Epidemiology

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