Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2019; 11(1): 24-37
Published online Jan 26, 2019. doi: 10.4330/wjc.v11.i1.24
Subclinical carotid atherosclerosis predicts all-cause mortality and cardiovascular events in obese patients with negative exercise echocardiography
Rafael Vidal-Perez, Raúl Franco-Gutiérrez, Alberto J Pérez-Pérez, Virginia Franco-Gutiérrez, Alberto Gascón-Vázquez, Andrea López-López, Ana María Testa-Fernández, Carlos González-Juanatey
Rafael Vidal-Perez, Raúl Franco-Gutiérrez, Alberto J Pérez-Pérez, Alberto Gascón-Vázquez, Andrea López-López, Ana María Testa-Fernández, Carlos González-Juanatey, Department of Cardiology, Hospital Universitario Lucus Augusti, Lugo 27003, Spain
Virginia Franco-Gutiérrez, Department of Otolaryngology, Hospital Carmen y Severo Ochoa, Cangas del Narcea 33800, Spain
Alberto Gascón-Vázquez, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela 15782, Spain
Author contributions: All authors helped to perform the research; Vidal-Perez R contributed to manuscript writing, performing procedures, and data analysis; Franco-Gutiérrez R contributed to manuscript writing, drafting of the document, conception and design of the study, and data analysis; Pérez-Pérez AJ, Franco-Gutierrez V, Gascón-Vázquez A and López-López A contributed to manuscript writing; Testa-Fernández AM and González-Juanatey C contributed to performing procedures, drafting of the document, and conception and design of the study.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
STROBE statement: The authors declare that the STROBE statement was followed in the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Raúl Franco-Gutiérrez, MD, Staff Physician, Department of Cardiology, Hospital Universitario Lucus Augusti, Av/Doctor Ulises Romero nº1, Lugo 27003, Spain. raul.franco.gutierrez@sergas.es
Telephone: +34-982296738 Fax: +34-982295390
Received: September 19, 2018
Peer-review started: September 19, 2018
First decision: October 26, 2018
Revised: December 16, 2018
Accepted: December 24, 2018
Article in press: December 24, 2018
Published online: January 26, 2019
ARTICLE HIGHLIGHTS
Research background

Obesity is independently associated with mortality and cardiovascular disease. However, once cardiovascular disease is established, the studies published so far show contradictory results. On the other hand, several epidemiological studies have demonstrated an independent association of carotid disease, defined as carotid plaques or carotid intima media thickness, with overall mortality and cardiovascular events.

Research motivation

There are no studies addressing the value of subclinical atherosclerosis, defined as carotid disease, and adverse events in obese patients with or without cardiovascular disease.

Research objectives

This study aimed to determine if carotid disease is a predictor of adverse events in obese patients with coronary artery disease suspicion and negative treadmill stress echocardiography.

Research methods

A retrospective cohort study of patients without significant heart or vascular disease, body mass index ≥ 30 kg/m2 and coronary artery disease suspicion with negative exercise echocardiography (EE) submitted to carotid ultrasonography. Between January 2006 and December 2010, 2000 patients were submitted for stress echocardiography and carotid ultrasonography in our centre. Of them, 226 (11.3%) were included. Adverse events were defined as all-cause mortality, myocardial infarction and cerebrovascular accident.

Research results

We found that 226 patients had body mass indexes ≥ 30 kg/m2, and 76 of them (33.6%) had carotid plaques. During a mean follow-up time of 8.2 (2.1) years, 27 adverse events were found (11.9%). Mean event-free survival at 1, 5 and 10 years was 99.1% (0.6), 95.1% (1.4) and 86.5% (2.7), respectively. In univariate analysis, carotid plaques predicted adverse events (hazard ratio (HR) 2.52, 95% confidence interval (CI) 1.17-5.46; P = 0.019). In multivariable analysis, the presence of carotid plaques remained a predictor of adverse events (HR 2.26, 95%CI 1.04-4.95, P = 0.041). Other predictors identified were glomerular filtration rate, metabolic equivalents and moderate mitral regurgitation.

Research conclusions

This study demonstrates that subclinical atherosclerosis defined by carotid plaques predicts adverse events in obese patients with negative EE.

Research perspectives

To the best of our knowledge, this is the first article that correlates subclinical atherosclerosis and adverse events in obese patients, and specifically in obese patients with suspicion of ischaemic heart disease and a good prognosis from EE. One lesson from this study is that these good prognosis patients could be further stratified with carotid imaging and, in the case of plaque presence, benefit from more aggressive prevention measures.