Achieving target blood pressure and LDL Cholesterol does not prevent the progression of atherosclerotic plaque burden in a high-risk population

Abstract

BACKGROUND AND AIMS: Atherosclerotic disease is a huge health burden worldwide, and its prevention is largely focused on controlling traditional risk factors, despite limited effectiveness in preventing cardiovascular disease (CVD) events. Improved risk stratification can be achieved by identifying the progression of total plaque area (TPA) using carotid ultrasound, with the risk of CVD events doubling when progression is detected over a 1-year interval. We hypothesize that blood pressure and serum LDL cholesterol control at target values (current clinical guidelines) are insufficient to reduce the progression of atherosclerosis in persons with high CVD risk METHODS AND RESULTS: Prospective, observational study of 742 participants with high cardiovascular risk in a cardiovascular primary prevention program. Two ultrasound measurements of TPA were acquired for each participant for at least one year. We studied only those who maintained a blood pressure below 130/80 mmHg and serum Low-Density Lipoprotein Cholesterol (LDL-C) below 100 mg/dl throughout the study interval (57 participants). Participants with plaque progression of TPA > 5 mm2, were compared to those with TPA changes of 5 mm2 or less (non-progression group) using a multivariable logistic regression controlling for cardiovascular risk factors. We identified TPA progression in 22 of 57 (38.6%) participants. No differences were detected for any covariate when comparing progression versus non-progression. CONCLUSION: Progression of TPA occurs in as many as 38.6% of individuals despite maintaining BP below 130/80 and serum LDL-C below 100 mg/dl. TPA evaluation may help address the limitations of established guidelines for the prevention of CVD events in high-risk individuals.