Co-existing Hypertension and Hyperhomocysteinemia Increases the Risk of Carotid Vulnerable Plaque and Subsequent Vascular Event: An MR Vessel Wall Imaging Study

Dongye Li; Huiyu Qiao; Xieqing Yang; Jin Li; Wei Dai; Xiaoyi Chen; Jun Shen; Xihai Zhao

doi:10.3389/fcvm.2022.858066

Co-existing Hypertension and Hyperhomocysteinemia Increases the Risk of Carotid Vulnerable Plaque and Subsequent Vascular Event: An MR Vessel Wall Imaging Study

Front Cardiovasc Med. 2022 Mar 30:9:858066. doi: 10.3389/fcvm.2022.858066. eCollection 2022.

Authors

Dongye Li¹, Huiyu Qiao², Xieqing Yang¹, Jin Li³, Wei Dai⁴, Xiaoyi Chen⁵, Jun Shen¹, Xihai Zhao²

Affiliations

¹ Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
² Department of Biomedical Engineering, Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China.
³ Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
⁴ Department of Neurology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
⁵ Department of Radiology, Beijing Geriatric Hospital, Beijing, China.

Abstract

Purpose: This study sought to determine the associations of co-existing hypertension and hyperhomocysteinemia (H-Hcy) with carotid vulnerable plaque features and subsequent vascular events.

Methods: Symptomatic patients with carotid atherosclerosis were enrolled and underwent carotid magnetic resonance (MR) vessel wall imaging. The patients were divided into the following groups: co-existing hypertension and H-Hcy group; isolated hypertension group; isolated H-Hcy group; and control group. The morphological and compositional characteristics of carotid plaques were assessed on MR images and compared among different groups. Univariate and multivariate cox regressions were used to calculate the hazard ratio (HR) and corresponding 95% confidence interval (CI) of co-existing hypertension and H-Hcy in predicting subsequent vascular events after at least 1-year followed-up.

Results: In total, 217 patients (mean age, 59.4 ± 11.9 years; 154 males) were recruited. Patients in co-existing hypertension and H-Hcy group had a significantly higher prevalence of carotid lipid-rich necrotic core (LRNC) than isolated H-Hcy and control group (73.2 vs. 43.3 vs. 50%, p = 0.015). During the median follow-up time of 12.2 ± 4.3 months, 61 (39.8%) patients experienced vascular events. After adjusting for baseline confounding factors, co-existing hypertension and H-Hcy (HR, 1.82; 95% CI, 1.01-3.27; p = 0.044), presence of carotid LRNC (HR, 2.25; 95% CI, 1.09-4.65; p = 0.029), and combination of co-existing hypertension and H-Hcy and carotid LRNC (HR, 2.39; 95% CI, 1.26-4.43; p = 0.007) were significantly associated with subsequent vascular events.

Conclusions: Co-existing hypertension and H-Hcy are associated with carotid vulnerable plaque features, such as LRNC. Combining co-existing hypertension and H-Hcy with carotid vulnerable plaque features has a stronger predictive value for subsequent vascular events than each measurement alone.

Keywords: atherosclerosis; homocysteine; hypertension; stroke; vulnerable plaque.