Carotid Intima Media Thickness and Plaques Can Predict the Occurrence of Ischemic Cerebrovascular Events

Abstract

Background and Purpose-The clinical usefulness of noninvasive measurement of carotid intima media thickness and plaque visualization in the general population is still uncertain. Methods-We evaluated the age-specific incidence rates of cerebrovascular events in a cohort of 1348 subjects randomly taken from the census list of San Daniele Township and followed for a mean period of 12.7 years. The association among common carotid intima media thickness, measured at baseline, arterial risk factors, and incidence of ischemic cerebrovascular events was modeled using Poisson regression. The predictive ability of common carotid intima media thickness over arterial risk factors (summarized in the Framingham Stroke Risk Score) was evaluated by receiver operating characteristic curve analysis. Results-During the follow-up, 115 subjects developed nonfatal ischemic stroke, transient ischemic attack, or vascular death, which were the predefined study end points. After adjustment for age and sex, hypertension, diabetes, common carotid intima media thickness above 1 mm, and carotid plaques were all independent risk factors for development of vascular events. Inclusion of carotid findings (presence of common carotid intima media thickness above 1 mm or carotid plaques) resulted in a predictive power higher than Framingham Stroke Risk Score alone only on for those subjects with a Framingham Stroke Risk Score over 20%. Conclusions-Although common carotid intima media thickness and presence of carotid plaques are known to be risk factors for the development of vascular events and to be independent from the conventional risk factors summarized in the Framingham Stroke Risk Score, their contribution to individual risk prediction is limited. Further studies will be required to address the role of carotid ultrasonography in the primary prevention of high-risk subjects.

The unresolved challenge of subjects at intermediate cardiovascular risk

“…In this regard, the findings of the present report are in keeping with a previous prospective study on an Italian population in which the incidence of cerebrovascular events is higher in patients at intermediate Framingham risk, but with presence of a carotid plaque than in those at high Framingham risk without the presence of carotid plaque as an additional risk factor [7].…”

“…For instance, the addition of carotid intima-media thickness (cc-IMT) and plaque is found to improve the Framingham risk score in subjects at high vascular risk [7]. Addition of multiple biomarker scores to a traditional risk factor model has also been recently evaluated, and shows some promises [8].…”

Risk factors of carotid plaque and carotid common artery intima‐media thickening in a high‐stroke‐risk population

“…Carotid intima‐media thickening (CIMT) and carotid plaque (CP) are considered to be surrogate subclinical markers of early atherosclerosis, are associated with stroke risk (Georgios et al., 2006; Rundek et al., 2015), and can predict the occurrence of ischemic cerebrovascular events (Prati et al., 2008). There is a study that found that increased common carotid artery stiffness is associated with ischemic stroke (Tsivgoulis et al., 2006).…”

Carotid atherosclerotic plaque characterisation by measurement of ultrasound sound speed in vitro at high frequency, 20MHz

“…The c-IMT measurement has also been shown to be an independent risk factor that correlates well with the Framingham Stroke Risk Score (FSRS), which is a calculation of 10-year stroke risk (Touboul et al 2005). This study used five hundred and ten (510) Indeed, in a cohort study of 1348 randomly selected subjects followed for 12.7 years, its contribution to individual risk prediction has been shown to be limited for the general population but may be useful only in high-risk groups (Prati et al 2008). …”