Essen Stroke Risk Score Predicts Carotid Atherosclerosis in Chinese Community Populations

Zhi-Xin Huang; Li-Hua Chen; Ran Xiong; Yan-Ni He; Zhu Zhang; Jie Zeng; Qiankun Cai; Zhenguo Liu

doi:10.2147/RMHP.S274340

Essen Stroke Risk Score Predicts Carotid Atherosclerosis in Chinese Community Populations

Risk Manag Healthc Policy. 2020 Oct 13:13:2115-2123. doi: 10.2147/RMHP.S274340. eCollection 2020.

Authors

Zhi-Xin Huang^#^{1

2}, Li-Hua Chen^#³, Ran Xiong⁴, Yan-Ni He⁴, Zhu Zhang^{1

2}, Jie Zeng⁵, Qiankun Cai⁶, Zhenguo Liu⁷

Affiliations

¹ Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China.
² Department of Neurology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
³ Department of Neurology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
⁴ Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China.
⁵ Department of Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China.
⁶ Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China.
⁷ Center for Precision Medicine and Division of Cardiovascular Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA.

^# Contributed equally.

Abstract

Background: Carotid atherosclerosis (CA) is closely related to stroke, and Framingham Risk Score (FRS) has been used for CA risk evaluation. However, FRS could only be used for subjects of up to 74 years old. The present study was to determine if Essen Stroke Risk Score (ESRS) could be used to estimate CA risk in community populations without age limits.

Methods: In the present prospective multi-community screening study, we evaluated the prevalence of CA using high-resolution ultrasound in 521 males and 1039 females (35 to 91 years old). Both FRS and ESRS were calculated for the subjects. Multivariate logistic regression analysis was used to determine the predictive values of FRS and ESRS for CA in these subjects.

Results: Ultrasound data showed that CA was present in 56.2% of the participants (total of 1560). Multivariate logistic regression analysis showed that ESRS was associated with CA with odds ratio (OR): 1.34 (95% confidence interval (CI), 1.12-1.60, p=0.001). Central obesity (OR: 1.40, CI: 1.07-1.83, p=0.015), female (OR: 0.55, CI: 0.39-0.77, p <0.001) and age (OR: 2.63, CI: 2.27-3.06, p <0.001) were also associated with CA. Based on the estimated area under curve (AUC), FRS (AUC 0.775) was better than ESRS (AUC 0.693) (z statistic 6.774, p <0.001) for CA prediction for individuals of ≤74 years old. However, receiver operating characteristic analysis showed ESRS was a good CA predictor for all subjects (AUC of 0.715).

Conclusion: ESRS could be used as an alternative to FRS to predict CA in community population of all age.

Keywords: ESRS; Essen Stroke Risk Score; carotid atherosclerosis; risk factors; stroke.

Grants and funding

This work was partially supported by the Science and Technology Program of Guangzhou, China (201707010436 to ZXH), Medical Scientific Research Foundation of Guangdong Province, China (B2019068 to ZXH) and Administration of Traditional Chinese Medicine of Guangdong Province, China (20181012 to ZXH). The funders had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript.