This cross-sectional study, spanning from December 2020 to December 2021, delves into the prevalence and risk factors of carotid artery stenosis and plaque across China. Involving 194,878 adults aged 40 and above from 31 provinces, the research leverages data from the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP), adhering to the STROBE reporting guideline. The study's objective is to address the knowledge gap regarding these conditions' prevalence and associated risk factors, which previous studies have inconsistently reported.
Participants were categorized into high-, medium-, and low-risk groups based on the National Stroke Association’s stroke risk scorecard. High-risk individuals underwent neck vascular ultrasound to detect abnormalities like carotid intimal thickening, plaque, stenosis, or occlusion. The study protocol, developed by the China Stroke Prevention Project Committee's General Office under the National Health Commission, included face-to-face interviews, physical examinations, and venous blood sample collection. A comprehensive questionnaire gathered data on demographic characteristics, laboratory test results, lifestyle-related risk factors, and individual and family medical histories.
The research revealed that among the participants, 994 (0.5%) had carotid artery stenosis, while 86,498 (44.4%) had carotid plaque. The mean age of participants was 63.2 years, with females constituting 54.2% and 49.2% residing in urban areas. The study found significant age-related correlations in prevalence rates, with higher rates in older age groups. Males exhibited higher standardized prevalence rates for both conditions compared to females. Urban residents, those with lower annual income, lower educational level, lower BMI, and individuals with health conditions such as hypertension, diabetes mellitus, hyperlipidemia, stroke, TIA, atrial fibrillation, smoking, and alcohol consumption had higher prevalence rates of carotid plaque.
Geographic disparities were evident, with the north and south regions showing the highest rates of carotid artery stenosis, while the southwest had the highest incidence of carotid plaque. Logistic regression analysis identified various risk factors associated with the onset of these conditions. Hypertension, diabetes mellitus, stroke, atrial fibrillation, and smoking were consistently linked to a higher risk of carotid artery stenosis, with stroke exhibiting the strongest association. For carotid plaque, a wide range of risk factors emerged, including hypertension, diabetes, hyperlipidemia, stroke, TIA, atrial fibrillation, smoking, drinking, and a family history of stroke.
Subgroup analyses by age, gender, and geographical regions provided further insights. Among participants aged 60 and older, the major risk factors aligned with the overall population. However, for those under 60, stroke was the sole risk factor for carotid artery stenosis. Gender-specific analysis revealed significant risk factors for males included diabetes mellitus, stroke, and smoking, while for females, significant risk factors were hypertension, diabetes mellitus, stroke, atrial fibrillation, and smoking.
The study emphasizes the need for targeted interventions and customized health education programs to reduce the prevalence of carotid artery stenosis and plaque in China. Increasing public awareness about the link between modifiable risk factors and these vascular anomalies is also crucial. The research offers significant epidemiological data to inform stakeholders, policymakers, and healthcare practitioners, aiding in the development of effective primary prevention strategies.
DOI: 10.1007/s11684-024-1088-0