Cardiovascular risk associated with carotid bifurcation plaques producing <50% stenosis and its modulation by presence of common femoral plaques: a cohort study

Andrew N Nicolaides*, Andrie G Panayiotou, Maura Griffin, Theodosis Tyllis, Dawn Bond, Niki Georgiou, Efthyvoulos Kyriacou, Costantinos Avraamides, Luca Saba, Elena Critselis, Christiana Demetriou, Despo Ierodiakonou, Annalisa Quattrocchi, Pascale Salameh, Eleni L Tolma, Christos Varounis, Richard M Martin

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background:
The aims were to determine the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) in individuals free from ASCVD (a) in the presence of carotid bifurcation plaques (CBP) < 3-mm thick and ⩾ 3 mm in comparison to a normal vessel wall and (b) the risk modulation in the presence or absence of additional common femoral bifurcations with plaques (CFBP) in a cohort study.

Methods:
A total of 1000 subjects aged 58.4 ± 10.5 years, free from ASCVD, were followed up for 15.2 ± 4.9 years (mean ± SD). The primary endpoint was a composite of first time fatal or nonfatal 10-year ASCVD events.

Results:
The 10-year risk of ASCVD was 6% in the absence of carotid plaques; 10% in the presence of unilateral and 23% in the presence of bilateral < 3-mm plaques (adjusted hazard ratio [HR] 1.65 [95% CI 1.11–2.47] and 2.03 [95% CI 1.32–3.00], respectively); and 29% for unilateral and 63% for bilateral 3–5 mm plaques (adjusted HR 2.40 [95% CI 1.41–4.09] and 3.78 [95% CI 1.77–8.06], respectively). In those with unilateral or bilateral < 3-mm CBP in the presence of two CFBP, the 10-year risk of ASCVD was 26% and 37% (adjusted HR 3.01 [95% CI 1.38–6.58] and 2.52 [95% CI 1.55–4.10], respectively). The 10-year risk was 2% in those without CBP or CFBP and 26% in those with two CFBP only.

Conclusions:
The presence of a < 3-mm CBP may be associated with a significant ASCVD risk, especially if bilateral. This risk is better defined by the additional presence or absence of two CFBPs.
Original languageEnglish
Pages (from-to)579-589
Number of pages11
JournalVascular Medicine
Volume30
Issue number5
Early online date23 Sept 2025
DOIs
Publication statusPublished - 1 Oct 2025

Bibliographical note

Publisher Copyright:
© The Author(s) 2025.

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