Cardiovascular disease risk categories based on SCORE algorithms and age: reclassification based on number of carotid and common femoral bifurcations with plaque

Background: The aim was to determine the efficacy of the number of carotid and common femoral bifurcations with plaque (NBP) detected by ultrasound in reclassifying individuals into atherosclerotic cardiovascular disease (ASCVD) risk categories based on SCORE2, SCORE2-OP algorithms and age. Data from the cohort of 908 individuals free from ASCVD and diabetes in the Cyprus Epidemiological Study on Atherosclerosis (CESA) was used. Methods: In each predicted ASCVD risk category (low to moderate, high and very high) the observed 10-year risk of subgroups according to the NBP was used to reclassify participants. Results: There were 183 ASCVD events during a mean follow-up of 15.5±4.6 years. The observed 10-year event rate was 4% in the low to moderate risk category, 7% in the high-risk category and 21% in the very high-risk category. The presence of more than one bifurcation with plaque up-classified 41 (16%) participants from the low to moderate category to a high-risk group (observed 10-year risk of 12%) with adjusted to SCORE2 and SCORE2-OP hazard ratio of 5.21 (95% CI 2.18 to 17.69) and 130 (40%) participants from the high-risk category to a very high-risk group (observed 10-year risk of 17%) with hazard ratio of 4.52 (95% CI 2.35 to 8.69). Concluslons: Because ultrasound is relatively inexpensive, and because ascertaining the presence of plaque in four superficial arterial bifurcations is a much easier and less time-consuming method than measurements of plaque thickness, area, or volume, this method has the potential for a practical clinical application.