Zhonghua Liu Xing Bing Xue Za Zhi. 2026 Apr 10;47(4):586-594. doi: 10.3760/cma.j.cn112338-20250916-00652.
ABSTRACT
Objective: To investigate the associations between multiple non-invasive atherosclerotic indicators and the risk of cardiovascular disease (CVD) outcomes in Chinese adults. Methods: Based on data from the second resurvey (2013-2014) of the China Kadoorie Biobank (CKB), covering 25 239 adults across 10 regions, this study excluded 4 366 participants with missing key covariates and 3 386 with a prior history of coronary heart disease or stroke. A total of 17 487 adults were initially included to describe baseline characteristics. After further excluding participants with missing data on specific non-invasive atherosclerotic indicators, the final sample sizes for the association analyses were 17 456 for carotid intima-media thickness (cIMT), 17 456 for carotid plaque, 17 272 for ankle-brachial index (ABI), and 13 916 for arterial stiffness indicators. Cox proportional hazards regression models were used to analyze the associations of the four non-invasive atherosclerotic indicators [cIMT, carotid plaque, ABI, and arterial stiffness indices(reflection index and stiffness index)] with the risks of ischemic heart disease (IHD), ischemic stroke (IS), hemorrhagic stroke (HS), major adverse cardiovascular events (MACE), and total CVD. Results: During an average follow-up of 7.8 years, 3 975 incident CVD events were observed. cIMT thickening (HR=1.16-1.31) and the presence of carotid plaque (HR=1.21-1.43) were independent risk factors for IHD, IS, HS, MACE, and total CVD. Specifically, cIMT thickening increased the risk of total CVD by 21% (HR=1.21, 95%CI: 1.12-1.31), and the presence of carotid plaque increased the risk of total CVD by 27% (HR=1.27, 95%CI: 1.18-1.37). Both cIMT and plaque burden scores showed significant positive dose-response relationships with the risks of the aforementioned outcomes (P for trend <0.05): for every 1.0 mm increase in cIMT, the risk increased by 48%-74% (HR=1.48-1.74); for every 1.00-point increase in plaque burden score, the risk increased by 11%-17% (HR=1.11-1.17). ABI demonstrated a non-linear U-shaped association with CVD risk, with the lowest risk observed in the ABI range of 1.0-1.3. However, after adjustment for multiple testing, ABI showed no statistically significant associations with any cardiovascular endpoints. Similarly, arterial stiffness indices (reflection index and stiffness index) showed no statistically significant associations with cardiovascular endpoints. Conclusions: Both cIMT thickening and carotid plaque burden are significantly associated with an elevated risk of CVD, suggesting that incorporating non-invasive atherosclerotic indicators, particularly those derived from carotid ultrasound, into risk assessment may facilitate more comprehensive risk stratification and prevention for high-risk CVD populations in China.
PMID:42020158 | DOI:10.3760/cma.j.cn112338-20250916-00652