Common carotid intima-media thickness is predictive of all-cause and cardiovascular mortality in elderly community-dwelling people: Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study

Abstract

Several cohort studies have examined the association of carotid intima-media thickness (IMT) with the risk of stroke or myocardial infarction in apparently healthy persons. We investigated the predictive value of IMT of cardiovascular mortality in elderly community-dwelling people, beyond the prediction provided by age and MMSE, assessed by means of a multivariate Cox model. Carotid IMT and plaque were evaluated bilaterally with ultrasonography in 298 people older than 75 years (120 men and 178 women, average age: 79.6 years). The LILAC study started on July 25, 2000. Consultations were repeated every year. The follow-up ended on November 30, 2004. During the mean follow-up span of 1152 days, 30 subjects (21 men and nine women) died. Nine deaths were attributable to cardiovascular causes (myocardial infarction: two men and three women; stroke: two men and two women). The age- and MMSE-adjusted relative risk (RR) and 95% confidence interval (95% CI) of developing all-cause mortality was assessed. A 0.3 mm increase in left IMT was associated with a RR of predicted 1.647 (1.075-2.524), and a similar increase in right IMT with a RR of 3.327 (1.429-7.746). For cardiovascular mortality, the corresponding RR values were 2.351 (1.029-5.372) and 2.890 (1.059-7.891), respectively. Carotid IMT assessed by ultrasonography is positively associated with an increased risk of all-cause and cardiovascular death in elderly community-dwelling people.

Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness

“…For the analysis, we focused on the data given in 12 publications on these 8 studies, [2][3][4][5][6][7][8][9][10][11][12]19 which represent 37 197 subjects. Table 1 provides an overview of the studies in terms of the study design, definition of clinical end points, observed population, sample size, follow-up period, carotid segments studied, definition of IMT, model construction (which accounts for potential bias factors), and report of results.…”

“…In particular, there are marked differences in age distribution, with a lower limit that ranges from 19 12 to 75 years. 19 Furthermore, the publications can be divided into 2 categories: those that use mean carotid IMT, determined from a number of IMT measurements at specific positions or by automated software over a segment of the artery, and those that use maximal carotid IMT. The Rotterdam Study is the only one in which IMT was determined by both methods in the same population.…”

“…The Rotterdam Study is the only one in which IMT was determined by both methods in the same population. 7,8 For further analyses, the Kuopio Ischemic Heart Disease Risk Factor Study, 2 the study reported by Kitamura et al, 9 and the Longitudinal Investigation for the Longevity and Aging in Hokkaido County 19 were excluded because they did not provide estimates that were comparable to the other studies.…”

Baseline Values but Not Treatment-Induced Changes in Carotid Intima-Media Thickness Predict Incident Cardiovascular Events in Treated Hypertensive Patients

“…Second, the relative predictive power of plaque or IMT measurements (either restricted to the common carotid or inclusive of bifurcation) is still debated. Most important, although several prospective intervention studies have shown that progression of IMT can be modified by antihypertensive and lipid-lowering agents, 8,16 -21 most of the prospective studies relating carotid IMT to cardiovascular outcomes have been observational, [1][2][3][4][5][6][7][9][10][11][12] and little is known of the relative predictive value of IMT measurements when modified by long-term treatment. Only data from a prospective observational study of plaque area progression 13 and from a very small interventional study, the Cholesterol Lowering Atherosclerosis Study 22 (CLAS), are available at present.…”

“…A number of prospective population or cohort studies such as the Atherosclerosis Risk in Communities Study 1,2 (ARIC), the Rotterdam Study, 3,4 the Cardiovascular Health Study 5 (CHS), and the Carotid Atherosclerosis Progression Study 6 (CAPS), as well as several smaller studies, [7][8][9][10][11][12] have shown that carotid intima-media thickness (IMT) is significantly related to incident cardiovascular events, both coronary events and stroke. There is also evidence that plaque presence 4 and carotid plaque area 13 measured by ultrasound are predictive of subsequent cardiovascular events.…”