Smoking habit as a putative risk factor for carotid plaque ulcers

Carotid plaque ulcers are thought to represent a cause for ischemic stroke. However, largely because the lack of reliable diagnostic methods, factors predisposing plaques to ulceration are not known. Based on ultrasound appearances, this study examined associations between carotid ulcers and traditional cardiovascular risk factors. The subjects comprised 1076 patients with carotid plaques as evidenced by ultrasound. Carotid ulcers were diagnosed by the presence of large obvious excavation (≥ 2 mm in depth) on the plaque surface, with a well-defined back wall at its base. As a putative associate for ulcers, severity of plaques was quantified by the plaque score. Prevalence of traditional cardiovascular risk factors was generally higher in patients with ulcers (n = 52) than in those not, so was average plaque score. When controlling for plaque score, smoking habit was found to be associated with 2.2 (95% CI: 1.1 to 4.6) fold higher likelihood for the existence of ulcers. We propose a possible role of smoking habit for the ulceration of carotid plaques.