ArticleJournal of the American Heart Association2024
Carotid Ultrasound-Based Plaque Score for the Allocation of Aspirin for the Primary Prevention of Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis and the Atherosclerosis Risk in Communities Study.
Article in Journal of the American Heart Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed.
- Aspirin in Primary Prevention of CVD: A Pragmatic Outline and Advice for Treatment Personalization.Journal of clinical medicine · 2026Review
- Risk prediction and prevention in patients with advanced subclinical atherosclerosis.BMC cardiovascular disorders · 2026Review
- Association of Composite Metabolic Indices With Incident Carotid Plaque: A Chinese Cohort Study.Journal of the American Heart Association · 2026Article
- Analysis of the Predictive Effect of Cardiac Color Doppler Ultrasound Combined With Carotid Ultrasound on Major Adverse Cardiac Events Following Percutaneous Coronary Intervention.Echocardiography (Mount Kisco, N.Y.) · 2025Article
- Coronary Artery Disease and Atherosclerosis in Other Vascular Districts: Epidemiology, Risk Factors and Atherosclerotic Plaque Features.Life (Basel, Switzerland) · 2025Review
- Future of Stroke Prevention: 7 Updates in the 2024 AHA/ASA Primary Prevention of Stroke Guideline.JACC. Advances · 2025Article
- Role of Aspirin in Reducing Risk for Atherosclerotic Cardiovascular Disease in Individuals with Elevated Lipoprotein(a).Current atherosclerosis reports · 2025Review
- Saudi Heart Association Position Statement on Early Detection of Subclinical Atherosclerosis in Clinical Practice.Journal of the Saudi Heart Association · 2025Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundCoronary artery calcium testing using noncontrast cardiac computed tomography is a guideline-indicated test to help refine eligibility for aspirin in primary prevention. However, access to cardiac computed tomography remains limited, with carotid ultrasound used much more often internationally. We sought to update the role of aspirin allocation in primary prevention as a function of subclinical carotid atherosclerosis. METHODS AND
resultsThe study included 11 379 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) and ARIC (Atherosclerosis Risk in Communities) studies. A harmonized carotid plaque score (range, 0-6) was derived using the number of anatomic sites with plaque from the left and right common, bifurcation, and internal carotid artery on ultrasound. The 5-year number needed to treat and number needed to harm as a function of the carotid plaque score were calculated by applying a 12% relative risk reduction in atherosclerotic cardiovascular disease (ASCVD) events and 42% relative increase in major bleeding events related to aspirin use, respectively. The mean age was 57 years, 57% were women, 23% were Black, and the median 10-year ASCVD risk was 12.8%. The 5-year incidence rates (per 1000 person-years) were 5.5 (4.9-6.2) for ASCVD and 1.8 (1.5-2.2) for major bleeding events. The overall 5-year number needed to treat with aspirin was 306 but was 2-fold lower for individuals with carotid plaque versus those without carotid plaque (212 versus 448). The 5-year number needed to treat was less than the 5-year number needed to harm when the carotid plaque score was ≥2 for individuals with ASCVD risk 5% to 20%, whereas the presence of any carotid plaque demarcated a favorable risk-benefit for individuals with ASCVD risk >20%.
conclusionsQuantification of subclinical carotid atherosclerosis can help improve the allocation of aspirin therapy.
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