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THE RELATIONSHIP BETWEEN CAROTID PLAQUE SCORE, CAROTID PLAQUE TYPE AND hsCRP

Author Block M Matangi, D Armstrong, U Jurt, D Brouillard, A Johri

Kingston, Ontario

Abstract:
BACKGROUND: High sensitivity CRP is a biomarker of inflammation and modest elevations are associated with atherosclerosis and increased cardiovascular risk. The purpose of our analysis is to see if there was any relationship between hsCRP and plaque burden (as indicated by plaque score) or plaque type (as indicated by plaque morphology and plaque surface).
METHODS: Our Cardiology database was searched for all patients who had a carotid Doppler examination and measurement of hsCRP within 90 days. Patients with any known history of vascular disease or currently taking a Statin or both were excluded. Plaque scores were divided onto 0, 1-2 and 3-6. Plaque morphology was defined as P1(homogeneous), P2 (heterogeous), P3 (calcified). Plaque surface was defined as S1 (smooth), S2 (irregular) and S3 (ulcerative). Patients were divided into those patients with plaque type of only P1S1 type and those who had only other forms of plaque, P1S2, P1S3, P2S1, P2S2, P2S3, P3S1, P3S2, or P3S3. ANOVA and the Student’s unpaired t-test were used where appropriate.
RESULTS: There were 952 separate patients who had hsCRP measured and a carotid Doppler. Six-hundred and thirty-seven were excluded due to known vascular disease or current Statin therapy or both. This left 315 patients for analysis. Forty-two had plaque(s) of only P1S1 type. There were 116 who had plaque(s) of any type except P1S1. There were significant differences in age, and maximal CCA IMT when compared to plaque score but no difference in hsCRP, Table 1. When plaque was separated according to plaque type there was a significant increase in hsCRP in those with P1S1 type (3.13±2.51, N=42) versus those with other plaque types (2.31±2.07, N=116), P=0.0406.
CONCLUSION: The relationship between plaque type, plaque burden and cardiovascular risk is likely very complex. Our data does not show any relationship between overall plaque burden and hsCRP but a definite relationship between plaque type. We believe the simple P1S1 plaque (homogeneous and smooth surface) likely represents a more active plaque type with ongoing inflammation. Our numbers were too small to detect any relationship between plaque burden and hsCRP in those patients with only P1S1 plaque type. However a definite trend was noted with an increase in hsCRP with increasing plaque burden in those with P1S1 type,Table 1.
Table 1.
Number Plaque score Age Max CCA IMT hsCRP
128 0 56.4 ± 10.1 0.92 ± 0.15 2.71 ± 2.15
113 1-2 62.0 ± 11.0 1.08 ± 0.32 2.48 ± 2.25
74 3-6 70.1 ± 9.1 1.53 ± 0.40 2.54 ± 1.98
315 ANOVA P<0.0001 P<0.0001 P=0.6927
Patients with only plaque type P1S1.
26 1 58.0 ± 10.8 1.03 ± 0.22 2.56 ± 2.31
12 2 54.6 ± 8.5 0.95 ± 0.23 3.85 ± 2.48
4 3-4 61.5 ± 6.8 0.95 ± 0.13 4.70 ± 2.58
42 ANOVA P=0.4293 P=0.5171 P=0.1285