Burden of carotid artery atherosclerosis in Chinese adults: Implications for future risk of cardiovascular diseases

Abstract

Background Population-based studies of ultrasound measures of carotid atherosclerosis are informative about future risks of cardiovascular disease. Design Cross-sectional studies of carotid artery atherosclerosis in 24,822 Chinese adults from the China Kadoorie Biobank and 2579 Europeans from the UK Biobank. Methods Mean intima-media thickness of the common carotid arteries and presence of carotid artery plaque were examined in the China Kadoorie Biobank study. The carotid intima-media thickness (cIMT) findings in Chinese (mean age 59 years) were compared with a European population (mean age 62 years). Results Overall, the mean cIMT in Chinese was 0.70 mm (SD 0.16) and increased with age by 0.08 mm (SE 0.008) per 10-years older age. About 31% of the Chinese had carotid plaques and the prevalence varied 10-fold with age (6% at 40-49 to 63% at 70-89 years) and four-fold by region (range, 14%-57%). After adjustment for age, sex and region, plaque prevalence was higher in smokers than in non-smokers (36% vs. 28%) and two-fold higher in individuals with systolic blood pressure ≥160 mmHg than those with systolic blood pressure <120 mmHg (44% vs. 22%) in the China Kadoorie Biobank study. Mean cIMT was similar in the younger Chinese and European adults, but increased more steeply with age in the Chinese ( p = 0.002). Conclusions About one-third of Chinese adults had carotid plaques. The rate of progression of carotid atherosclerosis with age was more extreme in the Chinese compared with the European population, highlighting the need for more intensive strategies for cardiovascular disease prevention in China.

Keywords: Atherosclerosis; carotid intima-media thickness; plaques.

Figure 1. Age-specific percentage with any carotid plaques, by quintiles of cIMT.

Values are adjusted for sex and geographic region.

Figure 2. Mean values of cIMT and percentage with plaque by geographic region.

Values for geographic region are classified into 3 groups (low, middle and high) and adjusted for sex.

Figure 3. Mean (95%CI) values of cIMT by age and hypertension groups in the Chinese and UK populations aged 45-74 years.

The values for cIMT in the Chinese were based on 21,062 individuals (mean age, 59 years) and in the UK population were based on 2579 individuals (mean age 63 years). The mean (SE) values in the Chinese (0.70 [0.001] mm) were greater than in the UK population (0.68 [0.003] mm, p<0.001)