Carotid Intima-Media Thickness and Presence or Absence of Plaque Improves Prediction of Coronary Heart Disease Risk

Abstract

STRUCTURED ABSTRACT Objectives We evaluated whether carotid intima-media thickness (C-IMT) and the presence or absence of plaque improved coronary heart disease (CHD) risk prediction when added to traditional risk factors (TRF). Background Traditional CHD risk prediction schemes need further improvement as the majority of the CHD events occur in the “low” and “intermediate” risk groups. C-IMT and presence of plaque on an ultrasound are associated with CHD and therefore could potentially help improve CHD risk prediction. Methods Risk prediction models (overall, in men and women) considered included TRF-only, TRF+C-IMT, TRF+plaque, and TRF+C-IMT+ plaque. Model predictivity was determined by calculating the area under the receiver operating characteristic curve (AUC) adjusted for optimism. Cox-proportional hazards models were used to estimate 10-year CHD risk for each model, and the number of individuals reclassified determined. Observed events were compared with expected events; and, the net reclassification index (NRI) was calculated. Results Of 13,145 eligible individuals (5,682 men; 7,463 women), ~23% were reclassified by adding C-IMT+plaque information. Overall, the addition of C-IMT and plaque separately or together to the TRF model improved the AUC which increased from 0.742 to 0.750, 0.751 and 0.755 for the TRF-only, TRF+C-IMT, TRF+plaque and TRF+C-IMT+plaque model respectively. The C-IMT+TRF+plaque model had a NRI of 9.9% when compared to TRF-only in the overall population. However, comparison of TRF+C-IMT+plaque with TRF+C-IMT or TRF+plaque only resulted in non-significant or modestly significant changes of the various statistical tests. Sex-specific analyses are presented in the manuscript. Conclusion Adding plaque and C-IMT to TRF improves CHD risk prediction in the ARIC study.

The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease

“…83 In an analysis from the Atherosclerosis Risk in Communities study, addition of CIMT and plaque detection via ultrasonography to traditional risk factors improved coronary heart disease risk prediction. 84 In the Multi-Ethnic Study of Atherosclerosis, CACS was a better predictor of CVD than was CIMT. 85 In a meta-analysis of 16 populationbased cohort studies, a low ABI (Յ0.90) was associated with approximately twice the 10-year total mortality, cardiovascular mortality, and major coronary event rates compared with the overall rate in each FRS category, 86 suggesting that ABI assessment may improve cardiovascular risk prediction beyond the FRS.…”

Carotid Atherosclerosis Detected by Ultrasonography: A National Cross‐Sectional Study

“…Carotid intima–media thickness (IMT) and carotid plaques, measured by carotid ultrasound, have been proposed as surrogate markers for predicting cognitive impairment and CVD risk 6, 9. Carotid ultrasound examination of CA has been conducted in several population studies10, 11, 12; however, the epidemiology of carotid lesions in China may be different from other regions because of differences in ethnic and racial groups.…”

Joint Effect of Carotid Plaque and C‐Reactive Protein on First‐Ever Ischemic Stroke and Myocardial Infarction?

“…On the other hand, carotid artery plaque assessment, including thickness and TPA, has been proposed as risk modifiers in CVD risk prediction, but formal reclassification analyses have not yet been fully evaluated 40. NRI added by plaque measures in CVD risk prediction has previously been reported by the ARIC (Atherosclerosis Risk in Communities) Study and Three City Study, with overall categorical NRI ranging from 7.7% to 13.1% 42, 43. Differences in plaque assessment, outcome of interest, definition of plaque categories, and incidence rates exist.…”