Supplementary Material for: The Correlation between Inflammatory Markers and Carotid Atherosclerotic Plaque Characteristics

Purpose: This study aimed to explore the relationship between serum inflammatory biomarkers and the carotid atherosclerotic plaque characteristics, given prior evidence suggesting a key role of inflammation in the development of atherosclerosis.
Methods: In this prospective study, patients with carotid atherosclerotic plaque were recruited. Serum high-sensitivity CRP (Hs-CRP), homocysteine (Hcy) concentrations, and neutrophil-to-lymphocyte ratio (NLR) were obtained for all enrolled patients. Carotid atherosclerosis characteristics (such as intraplaque hemorrhage (IPH) and lipid-rich necrotic core (LRNC) were determined by three-dimensional high-resolution vessel wall imaging. The associations between Hs-CRP, Hcy, NLR, and plaque characteristics were assessed.
Results: In total, 128 patients (84.4% men; mean age, 58.0 ±8.7 years) were included. Multivariate logistic regression indicated that increased Hs-CRP levels was associated with the presence of LRNC (OR=1.23, 95% CI:1.07–1.40, P=0.003) and IPH (OR=1.26, 95% CI:1.10–1.45, P=0.001). Multivariate linear regression confirmed a significant correlation between Hs-CRP level (β= 3.24, 95% CI: 0.66-5.81, P = 0.014) and the IPH volume. For plaque burden, higher Hs-CRP levels were associated with larger max normalized wall index (NWI) (β = 0.01, 95% CI: 0.00-0.02, P = 0.005) and larger Max wall thickness (WT) (β = 0.08, 95% CI: 0.02-0.14, P =0.006). NLR and Hcy levels did not showed significantly associations with the carotid plaque characteristics.
Conclusions: Elevated Hs-CRP levels were found to be closely associated with plaque burden and vulnerable plaque characteristics. The relationship between elevated Hs-CRP and plaque vulnerability highlights its potential role in risk stratification and early intervention strategies. Further validation in larger, multicenter population studies is required to confirm these associations.