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Carotid intima-media thickness at different sites: relation to incident myocardial infarction; The Rotterdam Study
A Iglesias del Sol1, M L Bots, D E Grobbee
1Department of Epidemiology & Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
Insights
Increased carotid intima-media thickness predicts future myocardial infarction. All measured sites, including the common carotid artery, carotid bifurcation, and internal carotid artery, showed similar predictive abilities for heart attacks.
Area of Science:
- Cardiovascular disease research
- Medical imaging analysis
- Predictive diagnostics
Background:
- Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis.
- Assessing CIMT may aid in predicting future cardiovascular events.
- Understanding the predictive value of different carotid artery segments is crucial.
Purpose of the Study:
- To determine if intima-media thickness (IMT) of the common carotid artery, carotid bifurcation, and internal carotid artery predicts myocardial infarction.
- To identify which IMT measurement offers the strongest predictive value for future myocardial infarction.
Main Methods:
- A case-cohort study design was employed within the Rotterdam Study.
- Ultrasound imaging was used to measure IMT in the common carotid artery, carotid bifurcation, and internal carotid artery.
- Cox regression analysis, adjusted for age and sex, was performed on the first 194 myocardial infarctions.
Main Results:
- Higher quartiles of common carotid, bifurcation, internal carotid, and combined IMT were associated with increased risk of myocardial infarction.
- Risk ratios for myocardial infarction per standard deviation increase in IMT were highest for combined measure (1.47) and common carotid artery (1.44).
- Areas under the ROC curves did not significantly differ between individual and combined IMT measurements.
Conclusions:
- Elevated carotid intima-media thickness is a significant predictor of future myocardial infarction.
- All assessed measurement sites (common carotid artery, carotid bifurcation, internal carotid artery) demonstrated comparable predictive capabilities for myocardial infarction.
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.
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