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Lipid-rich necrotic core of the carotid plaque and the risk of major adverse cardiovascular and cerebrovascular events: A meta-analysis and systematic review

epidemiology
neurology

Abstract

Background. Carotid atherosclerosis drives major adverse cardiovascular and cerebrovascular events (MACCEs), but the role of lipid-rich necrotic core (LRNC) remains controversial. We aimed to clarify this via systematic review and meta-analysis.

Methods. PubMed, Embase, Web of Science, and Cochrane were searched for studies reporting LRNC prevalence or size and MACCEs from inception to November 2024. Study quality (AHRQ/NOS tools) was performed.

Results. Our meta-analysis included 18 studies, involving 5,682 patients. Our results showed that in individuals with lipid-core-containing carotid plaques, the cumulative incidence of MACCEs was approximately 10.2% (95% CI [0.030, 0.295]). When a stroke occurred, the probability of it occurring on the same side as a lipid-core-containing plaque was approximately 64.6% (95% CI [0.5643, 0.72]). Moreover, the presence of a lipid core in carotid plaques was a risk factor for MACCEs, increasing their incidence (HR: 1.570, 95% CI [1.006, 2.450]; OR: 2.042, 95% CI [1.474, 2.828]). Compared with patients without MACCEs, those with MACCEs had larger mean LRNC volumes (MD: 8.284, 95% CI [1.353, 15.215]), larger maximum LRNC volumes (MD: 8.68, 95% CI [4.095, 13.265]), and a higher proportion of LRNC in the plaque (MD: 0.471, 95% CI [0.073, 0.868]). Additionally, patients with MACCEs had a higher proportion of lipid core volume in the plaque (MD: 2.283, 95% CI [0.354, 4.211]).

Conclusions. Despite limited studies, LRNC presence and size are MACCE risk factors, suggesting therapeutic targeting prevents MACCEs.

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