Femoral and Carotid Plaque and Coronary Calcium

Study Questions:

Does subclinical atherosclerosis in the femoral arteries improve prediction of coronary artery disease (CAD) beyond traditional risk factors?


Data from the AWHS (Aragon Workers’ Health Study) were used for the present analysis. This study comprises a cohort of middle-aged men (40-59 years of age) recruited from factory workers in Zaragoza, Spain, starting in 2009. Beginning in 2011, assessment of subclinical atherosclerosis was performed. Participants who completed carotid and femoral ultrasounds in addition to coronary computed tomography and assessment of traditional cardiovascular risk factors were included in this analysis. Subjects with incomplete data were excluded. Women participants were also excluded due to low numbers of female participants.


A total of 1,423 men (mean age 51 years) were included in this study. Subclinical atherosclerosis was observed in 72% of the participants. Plaque was most commonly observed in the femoral artery (54%). Coronary calcification was observed in 38% and carotid plaque was observed in 34% of the participants. The association of cardiovascular risk factors was strongest for the femoral arteries, as compared to the carotid or coronary arteries. The area under the curve for prediction of positive coronary artery calcium increased from 0.665 for traditional risk factors (dyslipidemia, smoking, hypertension, diabetes, and age) to 0.719 when femoral and carotid plaque were combined with risk factors (p > 0.001). In this model, the femoral odds ratio (2.58) exceeded the carotid odds ratio (1.80) for prediction of positive coronary artery calcium.


The investigators concluded that subclinical atherosclerosis was highly prevalent in this middle-aged male cohort. Association of risk factors and positive coronary artery calcium was stronger in the femoral arteries than the carotid arteries. Screening femoral arteries for plaque may be an effective, feasible strategy for prediction of CAD.


These data suggest that femoral artery plaque may be useful in the identification of men at increased risk for CAD and thus eligible for prevention therapies. Further research that includes more ethnic/racial groups and women is warranted.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Hypertension, Smoking

Keywords: Atherosclerosis, Coronary Artery Disease, Carotid Artery Diseases, Diabetes Mellitus, Dyslipidemias, Femoral Artery, Hypertension, Middle Aged, Primary Prevention, Risk Factors, Smoking, Tomography, Vascular Calcification

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