Is Carotid Intima-Media Thickness Useful in Cardiovascular Disease Risk Assessment?

Abstract

Background and Purpose-We determined the contribution of common carotid intima-media thickness (IMT) in the prediction of future coronary heart disease and cerebrovascular disease when added to established risk factors. Methods-We used data from a nested case-control study comprising 374 subjects with either an incident stroke or a myocardial infarction and 1496 controls. All subjects were aged 55 years and older and participated in the Rotterdam Study. Mean follow-up was 4.2 years (range, 0.1 to 6.5 years). We evaluated which correlates of coronary heart disease and cerebrovascular disease contribute to the prediction of either a new incident myocardial infarction or a stroke. Logistic regression modeling and the area under the receiver operating characteristic curve (ROC area) were used to quantify the predictive value of the established risk factors and the added value of IMT. Results-The ROC area of a model with age and sex only was 0.65 (95% CI, 0.62 to 0.69). Independent risk factors were previous myocardial infarction and stroke, diabetes mellitus, smoking, systolic blood pressure, diastolic blood pressure, and total and HDL cholesterol levels. These risk factors increased the ROC area from 0.65 to 0.72 (95% CI, 0.69 to 0.75). This model correctly predicted 17% of all subjects with coronary heart disease and cerebrovascular disease. When common carotid IMT was added to the previous model, the ROC area increased to 0.75 (95% CI, 0.72 to 0.78). When only the IMT measurement was used, the ROC area was 0.71 (95% CI, 0.68 to 0.74), and 14% of all subjects were correctly predicted. There was no difference in ROC area when different measurement sites were used. Conclusions-Adding IMT to a risk function for coronary heart disease and cerebrovascular disease does not result in a substantial increase in the predictive value when used as a screening tool. (Stroke. 2001;32:1532-1538.)

Predictive Value of Noninvasive Measures of Atherosclerosis for Incident Myocardial Infarction

“…For purposes of MI risk stratification, the measurement of extracoronary atherosclerotic disease as an indication of the presence of unknown or unmeasured cardiovascular risk factors, such as genetic predisposition or inflammation, 21,22 may therefore be a meaningful addition to the measurement of traditional cardiovascular risk factors. Although the measurement of carotid IMT is unlikely to be of use as a screening tool in the general population, 23 measurement of the AAI has been suggested to be useful in persons Ն50 years old or persons at high risk. 24 However, the hazard ratios for MI associated with lower-extremity atherosclerosis were slightly lower in the present study than those associated with the other measures of atherosclerosis, which may be explained by the fact that the AAI is an indirect measure of lower-extremity atherosclerosis, which may also be influenced by hemodynamic factors and vascular stiffness.…”

Assessment of spatial inhomogeneities in intima media thickness along an arterial segment using its dynamic behavior

“…To get a more specific and sensitive indicator, either multiple properties have to be determined simultaneously (9) or one property has to be determined several times separated either in space or time. The ankle arm pressure index is an example of a simultaneously assessed property separated in space (23).…”

Predictors of aortic complicated lesions in stroke patients

“…This result accords with the finding of the Rotterdam Study that direct aortic PWV is strongly associated with the severity of plaque in the aorta. [23][24][25] A strong relationship between aortic PWV and baPWV has been reported. 14 Non-invasive measurement of baPWV thus appears to be more useful than direct PWV for evaluating ACL (44.0 mm).…”