Abstract

Aims We examined whether intima–media thickness of the common carotid artery, carotid bifurcation, internal carotid artery and the combined measure are predictive of future myocardial infarction and which of the measurements has the strongest predictive value.

Methods and Results We used a case–cohort approach in the Rotterdam Study. Ultrasound images of the common carotid artery, carotid bifurcation and the internal carotid artery were made. We selected the first 194 myocardial infarctions in the total population (mean follow-up 4·6 years). Analyses were done using Cox regression with adjustment for age and sex. The risk ratios (RR) for myocardial infarction associated with mean maximum common carotid, bifurcation, internal carotid intima-media thickness and the combined measurements were 3·18 (95% confidence interval, 1·83–5·54), 4·11 (2·10–8·05), 5·31 (1·77–15·9) and 6·27 (3·27–12·0), respectively, for the highest compared to the lowest quartile. The RRs for myocardial infarction per standard deviation increase of common carotid, bifurcation, internal carotid artery and combined intima-media thickness were 1·44 (1·28–1·62), 1·34 (1·17–1·53), 1·12 (0·94–1·33) and 1·47 (1·31–1·65), respectively. The areas under the ROC curves for the three measurements and the combined measure were not significantly different.

Conclusions Increased carotid intima-media thickness is a strong predictor of future myocardial infarction and all measurement sites have the same ability to predict future myocardial infarction. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

f1
Correspondence: J. C. M. Witteman, PhD, Department of Epidemiology & Biostatistics, Erasmus University Medical School, P.O.B. 1738, 3000 DR Rotterdam, The Netherlands.

References

1
Heiss
G
, Sharrett AR, Barnes R, Chambless LE, Szklo M, Alzola C. Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study.
Am J Epidemiol
 .
1991
;
134
:
250
–256
2
Wendelhag
I
, Wiklund O, Wikstrand J. Arterial wall thickness in familial hypercholesterolemia. Ultrasound measurement of intima-media thickness in the common carotid artery.
Arterioscler Thromb
 .
1992
;
12
:
70
–77
3
Bots
ML
, Hofman A, de Bruyn AM, de Jong PT, Grobbee DE. Isolated systolic hypertension and vessel wall thickness of the carotid artery. The Rotterdam Elderly Study.
Arterioscler Thromb
 .
1993
;
13
:
64
–69
4
Simons
PC
, Algra A, Bots ML, Grobbee DE, van der Graaf Y. Common carotid intima-media thickness and arterial stiffness: indicators of cardiovascular risk in high-risk patients. The SMART Study (Second Manifestations of ARTerial disease).
Circulation
 .
1999
;
100
:
951
–957
5
Bots
ML
, Witteman JC, Grobbee DE. Carotid intima-media wall thickness in elderly women with and without atherosclerosis of the abdominal aorta.
Atherosclerosis
 .
1993
;
102
:
99
–105
6
Bots
ML
, Hofman A, Grobbee DE. Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study.
Arterioscler Thromb
 .
1994
;
14
:
1885
–1891
7
Bots
ML
, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study.
Circulation
 .
1997
;
96
:
1432
–1437
8
Chambless
LE
, Heiss G, Folsom AR. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993.
Am J Epidemiol
 .
1997
;
146
:
483
–494
9
Hodis
HN
, Mack WJ, LaBree L. The role of carotid arterial intima-media thickness in predicting clinical coronary events.
Ann Intern Med
 .
1998
;
128
:
262
–269
10
Chambless
LE
, Folsom AR, Clegg LX. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) study.
Am J Epidemiol
 .
2000
;
151
:
478
–487
11
O'Leary
DH
, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group.
N Engl J Med
 .
1999
;
340
:
14
–22
12
O'Leary
D
, Polak JF, Kronmal RA. Thickening of the carotid wall. A marker for atherosclerosis in the elderly? Cardiovascular Health Study Collaborative Research Group.
Stroke
 .
1996
;
27
:
224
–231
13
Hofman
A
, Grobbee DE, de Jong PT, van den Ouweland FA. Determinants of disease and disability in the elderly: the Rotterdam Elderly Study.
Eur J Epidemiol
 .
1991
;
7
:
403
–422
14
Lamberts
H
, Wood M, Hofmans-Okkes I. The International Classification of Primary Care in the European Community. London: Oxford University Press; 1991.
15
Bots
ML
, van Meurs JCHM, Grobbee DE. Assessment of early atherosclerosis: a new perspective.
J Drug Res
 .
1991
;
16
:
150
–154
16
Wendelhag
I
, Gustavsson T, Suurkula M, Berglund G, Wikstrand J. Ultrasound measurement of wall thickness in the carotid artery: fundamental principles and description of a computerized analysing system.
Clin Physiol
 .
1991
;
11
:
565
–577
17
Grobbee
DE
, Bots ML. Carotid artery intima-media thickness as an indicator of generalized atherosclerosis.
J Intern Med
 .
1994
;
236
:
567
–573
18
Bots
ML
, Mulder PG, Hofman A, van Es GA, Grobbee DE. Reproducibility of carotid vessel wall thickness measurements. The Rotterdam Study.
J Clin Epidemiol
 .
1994
;
47
:
921
–930
19
Breslow
NE
, Day NE. Statistical methods in cancer research. Volume II—The design and analysis of cohort studies.
IARC Sci Publ
 .
1987
;
82
:
1
–406
20
Barlow
WE
, Ichikawa L, Rosner D, Izumi S. Analysis of case-cohort designs.
J Clin Epidemiol
 .
1999
;
52
:
1165
–1172
21
Barlow
WE
. Robust variance estimation for the case-cohort design.
Biometrics
 .
1994
;
50
:
1064
–1072
22
Salonen
JT
, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease.
Arterioscler Thromb
 .
1991
;
11
:
1245
–1249
23
Salonen
JT
, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression.
Circulation
 .
1993
;
87
:
II56
–65

Comments

0 Comments