Predictors of carotid plaque progression over a 4-year follow-up in the Reykjavik REFINE-study
Background and aims:
Carotid plaque is an arterial marker suggested as a surrogate end point for cardiovascular
disease. The aim of this study was to examine the association of risk factors at visit 1 with
plaque formation and progression of total plaque area (TPA) during follow-up.
We examined 1894 participants (50e69 years of age) in the population-based REFINE (Risk
Evaluation For INfarct Estimates)-Reykjavik study.
Among those with no plaque at baseline, plaque formation was associated with low density
lipoprotein, sex, waist, former smoker and physical activity. Furthermore, both the Icelandic Heart Association
(IHA) coronary heart disease (CHD) risk score and the atherosclerotic cardiovascular disease
(ASCVD) risk score were highly associated with plaque formation in these individuals (p < 0.001) and a
better cardiovascular health score was protective. In those with plaque present at baseline, metabolic
syndrome was associated with increased risk, while older age and statin use were associated with
reduced risk of new plaque formation. Statin use was the only factor associated with the relative TPA
progression, where participants not on treatment had 5.7% (p¼0.029) greater rate of progression
compared with statin users.
A number of conventional risk factors at visit 1 were individually associated with plaque
formation, also when combined into CHD and ASCVD risk scores, but not with the relative progression in
TPA. Medical intervention with statins can reduce the relative progression rate of TPA in the general
population with low