Neck Circumference as a Predictor of Cardiovascular Disease

Acute coronary syndrome ( ACS) is considered the most serious clinical symptom of atherosclerotic cardiovascular disease (ASCVD). Calcified plaques represent advanced atherosclerosis of the coronary arteries and the presence of ASCVD. Coronary artery calcification score (CACS) obtained by coronary CT angiography (CCTA) with the Agatston method has been widely used to quantify the global plaque burden of coronary atherosclerosis and can therefore predict cardiovascular events. major adverse events (MACE) in the future as a beneficial complement to traditional cardiovascular disease risk scoring.

Multicenter studies of atherosclerosis studies have shown that CACS is a powerful predictor of MACE and provides clinical information beyond traditional high-risk factors associated with ASCVD. However, the CACS easily ignores that low-attenuation plaque is the strongest predictor of fatal or nonfatal myocardial infarction. Hussain et al. found that more than a quarter of ASCVD patients did not have short-term coronary artery calcification (CAC). In addition, CCTA may cause some potential adverse reactions, such as allergic reactions and kidney failure caused by contrast agents, which are expensive, time-consuming, and not easy to popularize, so it is not conducive to widespread use for identification. and early detection of coronary events in the clinic.

In recent decades, cardiovascular diseases and adverse events have increased dramatically due to the explosion of metabolic syndrome (MetS) characterized by visceral obesity. Although the causality between MetS and MACE such as ACS is controversial, nowadays molecular epigenetics, epidemiology and clinical medicine have gradually recognized the view that visceral fat in the upper body is prone to release inflammatory cytokines, induce adipocytokine dysregulation and insulin resistance, and will ultimately lead to ASCVD and MACE.

In contrast, fat stored in the lower body acts as a metabolic buffer , protecting other tissues from lipid spillover and toxicity caused by ectopic fat, and plays a role in protecting organ functions. In recent years, researchers have been committed to finding a simple, accurate and reliable anthropometric index or biochemical indicator of visceral adipose tissue to predict the risk and prognosis of cardiovascular events.

Currently, many methods are applied to detect abdominal or visceral obesity, including anthropometric indices such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and neck circumference. (NC), and examination of images such as x-rays and computed tomography. Due to radiation exposure, allergy to contrast agents, potential damage to kidney function, time requirement, contraindications of gestation, and high cost, radiography is not suitable for routine clinical examination. and screening of the general population.

In this study, we analyzed data since 2015 on elderly patients with ACS in our hospital to explore: (1) the relationship between NC and common risk factors for MetS and cardiovascular disease; (2) the correlations between NC, MetS, CACS, coronary heart disease severity, and MACE; (3) the comparison of strength of NC, WC and TyG indices in predicting MACE and (4) the optimal cut-off value of NC in predicting MACE in Chinese elderly patients with ACS. Through the above studies, the association between NC, MetS and its components, and CACS was validated, and finally the ability of NC to predict the severity of coronary artery lesions and MACE was determined.

Background and objectives

Our objective was to investigate whether neck circumference (NC) can predict metabolic syndrome (MetS), coronary calcification and lesion, and major adverse cardiovascular events (MACE).

Methods

A total of 867 acute coronary syndrome (ACS) patients over 60 years of age from the Second Hospital of Shandong University, who had undergone coronary CT scan, were randomly selected for retrospective analysis .

Neck circumference ( NC) was measured when the patient was admitted or at the first visit to the clinic or inpatient ward. Participants were advised to sit upright and look straight ahead. The non-elastic tape was applied to the neck, below the throat. Male NC was measured below the laryngeal prominence and female NC was measured at the midpoint between the top of the neck and the top of the sternum. Medical conditions that affected NC measurements, such as goiter, spinal abnormalities, or Cushing’s syndrome, were excluded.

Subjects were divided into male and female groups, NC 1 to 4 quartile groups (Q1-Q4 groups), non-multivessel coronary artery disease (non-MVCD) groups, and multivessel coronary artery disease (MVCD) groups.

Results

After adjusting for potential confounders, CN was associated with risk factors promoting coronary artery disease (CAD) and coronary artery calcification score (CACS).

DKA severity increased 0.202-fold and 0.372-fold for each unit of NC in the male and female groups, respectively. Compared with the lower CACS group, the risk of coronary calcification increased 0.139-fold and MVCD increased 0.268-fold, with each unit increase of NC.

Except for all-cause death, there were significant differences between groups Q1-Q4 in the prevalence of all primary endpoints, cardiogenic death, unexpected rehospitalization for heart failure, ACS recurrence or unplanned revascularization, and nonfatal stroke. (p .log rank <0.01).

In view of the general trend, with the increase of NC quartiles, the prevalence of MACE gradually increased (all p < 0.01).