Prevalence and associated risk factors of carotid plaque and artery stenosis in China: a population-based study

Abstract

Stroke is a critical health issue in China, and carotid artery stenosis and plaque play key roles in its prevalence. Despite the acknowledged significance of this condition, detailed information regarding the prevalence of carotid artery stenosis and plaque across the Chinese population has been scarce. This study analyzed data from the China Stroke High-risk Population Screening and Intervention Program for 2020–2021, focusing on 194 878 Chinese adults aged 40 years and above. It assessed the prevalence of carotid artery stenosis and plaque and identified their associated risk factors. Results revealed a standardized prevalence of 0.40% for carotid artery stenosis and 36.27% for carotid plaque. Notably, the highest rates of stenosis were observed in north and south China at 0.61%, while southwestern China exhibited the highest plaque prevalence at 43.17%. Key risk factors included older age, male gender, hypertension, diabetes, stroke, smoking, and atrial fibrillation. This study highlights significant geographical and demographic disparities in the prevalence of these conditions, underlining the urgent need for targeted interventions and policy reforms. These measures are essential for reducing the incidence of stroke and improving patient outcomes, addressing this significant health challenge in China.

Keywords

carotid plaque / carotid artery stenosis / prevalence / risk factors / Bigdata Observatory Platform for stroke in China

References

[1] Katan M, Luft A. Global burden of stroke. Semin Neurol 2018; 38(2): 208–211

[2] GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20(10): 795–820

[3] GBD 2017 DALYs, HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1859–1922

[4] Gao Y, Jiang B, Sun H, Ru X, Sun D, Wang L, Wang L, Jiang Y, Feigin VL, Wang Y, Wang W. The burden of stroke in China: results from a nationwide population-based epidemiological survey. PLoS One 2018; 13(12): e0208398

[5] Liu L, Wang D, Wong KSL, Wang Y. Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke 2011; 42(12): 3651–3654

[6] Tu WJ, Hua Y, Yan F, Bian H, Yang Y, Lou M, Kang D, He L, Chu L, Zeng J, Wu J, Chen H, Han J, Ma L, Cao L, Wang L. Prevalence of stroke in China, 2013–2019: a population-based study. Lancet Reg Health West Pac 2022; 28: 100550

[7] Paraskevas KI, Nicolaides AN, Kakkos SK. Asymptomatic Carotid Stenosis and Risk of Stroke (ACSRS) study: what have we learned from it. Ann Transl Med 2020; 8(19): 1271

[8] Messas E, Goudot G, Halliday A, Sitruk J, Mirault T, Khider L, Saldmann F, Mazzolai L, Aboyans V. Management of carotid stenosis for primary and secondary prevention of stroke: state-of-the-art 2020: a critical review. Eur Heart J Suppl 2020; 22(Suppl M): M35–M42

[9] Xie Y, Yu M, Qing T, Luo H, Shao M, Wei W, Yi X. Variants in genes related to inflammation and endothelial function can increase the risk for carotid atherosclerosis in southwestern China. Front Neurol 2023; 14: 1174425

[10] Tang X, Zhang L, Li Y, Zhou Y, Cai X, Yao Y, Fang Q. Relationship between triglyceride–glucose index and carotid plaques in a high-stroke-risk population in southeast China: a population-based cross-sectional survey. Front Endocrin 2022; 13: 1023867

[11] Lin Y, Li Y, Li Z, Zhang Z, Liu J, Sun J, Tu J, Wang J, Zhang W, Li J, Ning X. Sex-related differences in the incidence and development of carotid plaques in a low-income Chinese population—a prospective cohort study. Int J Womens Health 2022; 14: 787–795

[12] Wang A, Tian X, Zuo Y, Wu J, Tang H, Wang Y, Zhao X. Association of remnant cholesterol with intra- and extra-cranial atherosclerosis in Chinese community population. Atheroscler Plus 2021; 46: 20–26

[13] Zhang Z, Fang X, Hua Y, Liu B, Ji X, Tang Z, Wang C, Guan S, Wu X, Liu H, Gu X. Combined effect of hyperhomocysteinemia and hypertension on the presence of early carotid artery atherosclerosis. J Stroke Cerebrovasc Dis 2016; 25(5): 1254–1262

[14] Yuan C, Lai CWK, Chan LWC, Chow M, Law HKW, Ying M. Cumulative effects of hypertension, dyslipidemia, and chronic kidney disease on carotid atherosclerosis in Chinese patients with type 2 diabetes mellitus. J Diabetes Res 2014; 2014: 179686

[15] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370(9596): 1453–1457

[16] Chao BH, Yan F, Hua Y, Liu JM, Yang Y, Ji XM, Peng B, Zhao GG, Wang YJ, Kang DZ, Wang YL, Zeng JS, Chu L, Li TX, Xu YM, Liu M, He L, Xu Y, Wu J, Lou M, Yue W, Cao L, Tu WJ, Wang LD. Stroke prevention and control system in China: CSPPC-Stroke Program. Int J Stroke 2021; 16(3): 265–272

[17] Ferguson GG, Eliasziw M, Barr HWK, Clagett GP, Barnes RW, Wallace MC, Taylor DW, Haynes RB, Finan JW, Hachinski VC, Barnett HJM. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 1999; 30(9): 1751–1758

[18] Song P, Fang Z, Wang H, Cai Y, Rahimi K, Zhu Y, Fowkes FGR, Fowkes FJI, Rudan I. Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling study. Lancet Glob Health 2020; 8(5): e721–e729

[19] Fu J, Deng Y, Ma Y, Man S, Yang X, Yu C, Lv J, Wang B, Li L. National and provincial-level prevalence and risk factors of carotid atherosclerosis in Chinese adults. JAMA Netw Open 2024; 7(1): e2351225

[20] Dossabhoy S, Arya S. Epidemiology of atherosclerotic carotid artery disease. Semin Vasc Surg 2021; 34(1): 3–9

[21] de Weerd M, Greving JP, Hedblad B, Lorenz MW, Mathiesen EB, O’Leary DH, Rosvall M, Sitzer M, Buskens E, Bots ML. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke 2010; 41(6): 1294–1297

[22] Mathiesen EB, Joakimsen O, Bonaa KH. Prevalence of and risk factors associated with carotid artery stenosis: the Tromso Study. Cerebrovasc Dis 2001; 12(1): 44–51

[23] Clarke R, Du H, Kurmi O, Parish S, Yang M, Arnold M, Guo Y, Bian Z, Wang L, Chen Y, Meijer R, Sansome S, McDonnell J, Collins R, Li L, Chen Z. Burden of carotid artery atherosclerosis in Chinese adults: implications for future risk of cardiovascular diseases. Eur J Prev Cardiol 2017; 24(6): 647–656

[24] Zhao W, Wu Y, Shi M, Bai L, Tu J, Guo Z, Jiang R, Zhang J, Ning X, Wang J. Sex differences in prevalence of and risk factors for carotid plaque among adults: a population-based cross-sectional study in rural China. Sci Rep 2016; 6(1): 38618

[25] van Dam-Nolen DHK, van Egmond NCM, Dilba K, Nies K, van der Kolk AG, Liem MI, Kooi ME, Hendrikse J, Nederkoorn PJ, Koudstaal PJ, van der Lugt A, Bos D. Sex differences in plaque composition and morphology among symptomatic patients with mild-to-moderate carotid artery stenosis. Stroke 2022; 53(2): 370–378

[26] Sturlaugsdottir R, Aspelund T, Bjornsdottir G, Sigurdsson S, Thorsson B, Eiriksdottir G, Gudnason V. Prevalence and determinants of carotid plaque in the cross-sectional REFINE-Reykjavik study. BMJ Open 2016; 6(11): e012457

[27] Chou CL, Wu YJ, Hung CL, Liu CC, Wang SD, Wu TW, Wang LY, Yeh HI. Segment-specific prevalence of carotid artery plaque and stenosis in middle-aged adults and elders in Taiwan: a community-based study. J Formos Med Assoc 2019; 118(1): 64–71

[28] Kuo F, Gardener H, Dong C, Cabral D, Della-Morte D, Blanton SH, Elkind MSV, Sacco RL, Rundek T. Traditional cardiovascular risk factors explain the minority of the variability in carotid plaque. Stroke 2012; 43(7): 1755–1760

[29] Fabris F, Zanocchi M, Bo M, Fonte G, Poli L, Bergoglio I, Ferrario E, Pernigotti L. Carotid plaque, aging, and risk factors. A study of 457 subjects. Stroke 1994; 25(6): 1133–1140

[30] Lu SX, Wu TW, Chou CL, Cheng CF, Wang LY. Combined effects of hypertension, hyperlipidemia, and diabetes mellitus on the presence and severity of carotid atherosclerosis in community-dwelling elders: a community-based study. J Chin Med Assoc 2023; 86(2): 220–226

[31] Nelson RH. Hyperlipidemia as a risk factor for cardiovascular disease. Primary Care 2013; 40(1): 195–211

[32] Ahmed ST, Li R, Richardson P, Ghosh S, Steele L, White DL, Djotsa AN, Sims K, Gifford E, Hauser ER, Virani SS, Morgan R, Delclos G, Helmer DA. Association of atherosclerotic cardiovascular disease, hypertension, diabetes, and hyperlipidemia with Gulf war illness among Gulf War veterans. J Am Heart Assoc 2023; 12(19): e029575

[33] Laguzzi F, Baldassarre D, Veglia F, Strawbridge RJ, Humphries SE, Rauramaa R, Smit AJ, Giral P, Silveira A, Tremoli E, Hamsten A, de Faire U, Frumento P, Leander K. Alcohol consumption in relation to carotid subclinical atherosclerosis and its progression: results from a European longitudinal multicentre study. Eur J Nutr 2021; 60(1): 123–134

[34] Britton A, Hardy R, Kuh D, Deanfield J, Charakida M, Bell S. Twenty-year trajectories of alcohol consumption during midlife and atherosclerotic thickening in early old age: findings from two British population cohort studies. BMC medicine 2016; 14(1): 111

[35] Oreopoulos A, Kalantar-Zadeh K, Sharma AM, Fonarow GC. The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med 2009; 25(4): 643–659

[36] Haberka M, Skilton M, Biedroń M, Szóstak-Janiak K, Partyka M, Matla M, Gąsior Z. Obesity, visceral adiposity and carotid atherosclerosis. J Diabetes Complications 2019; 33(4): 302–306

[37] Pan X, Chen X, Ren L, Li Z, Chen S. Correlation of obesity and overweight with cervical vascular function among healthy populations. Diabetes Metab Syndr Obes 2022; 15: 2927–2938

[38] Shen P, Zhou Y, Song A, Wan Y, Fan Z, Xu R. The association of metabolic health obesity with incidence of carotid artery plaque in Chinese adults. Nutr Metab Cardiovasc Dis 2021; 31(8): 2376–2381

[39] Hunt KJ, Duggirala R, Göring HHH, Williams JT, Almasy L, Blangero J, O’Leary DH, Stern MP. Genetic basis of variation in carotid artery plaque in the San Antonio Family Heart Study. Stroke 2002; 33(12): 2775–2780

[40] Bi Y, Qin Y, Su J, Cui L, Du WC, Miao WG, Li XB, Zhou JY. Prevalence and influencing factors of carotid plaque in population at high-risk for cardiovascular disease in Jiangsu province. Chinese Journal of Epidemiology (Zhonghua Liuxingbingxue Zazhi) 2019; 40(11): 1432–1438

[41] Zhang K, Lin Q, Zhang T, Guo D, Cao L. Contemporary prevalence and risk factors of carotid artery stenosis in asymptomatic low-income Chinese individuals: a population-based study. Postgrad Med 2020; 132(7): 650–656

RIGHTS & PERMISSIONS

Higher Education Press