Protocol for measuring carotid intima-media thickness that best correlates with cardiovascular risk and target organ
Manuel A Gómez-Marcos1, José I Recio-Rodríguez, María C Patino-Alonso
1Primary Care Research Unit, La Alamedilla, University of Salamanca, Sacyl. REDIAPP, IBSAL, Salamanca, Spain. magomez@usal.es
Insights
The mean common carotid intima-media thickness (CC-IMT) measurement best predicts cardiovascular risk and target organ damage. This protocol involves averaging 120 measures across both carotid arteries, enhancing cardiovascular risk assessment.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Diagnostic Imaging
Background:
- Cardiovascular risk stratification and target organ damage (TOD) assessment are crucial in managing hypertensive and diabetic patients.
- Common carotid intima-media thickness (CC-IMT) is a marker of subclinical atherosclerosis.
- Identifying the optimal CC-IMT measurement for predicting cardiovascular risk (CVR) and TOD is essential.
Purpose of the Study:
- To determine which CC-IMT measurement best correlates with overall cardiovascular risk (CVR) and vascular, cardiac, and renal target organ damage (TOD).
- To compare different CC-IMT measurement protocols in diabetic, hypertensive, and healthy subjects.
Main Methods:
- A cross-sectional study included 305 participants (113 hypertensive, 100 diabetic, 92 healthy), aged 30-75 years.
- Evaluated mean and maximum CC-IMT, ankle-brachial index (ABI), pulse wave velocity (PWV), glomerular filtration rate (GFR), albumin/creatinine ratio, and Cornell voltage-duration product (VDP).
- Cardiovascular risk was assessed using the Framingham equation and SCORE models.
Main Results:
- CC-IMT demonstrated positive correlations with CVR, PWV, and Cornell VDP, and negative correlations with ABI and GFR (P < 0.001).
- Mean CC-IMT showed the highest odds ratio (OR) for TOD (1.85), while maximum CC-IMT in posterior projections had the lowest (1.42).
- Each unit increase in mean CC-IMT predicted a 1.98-fold increase in risk (Framingham), significantly higher than maximum CC-IMT.
Conclusions:
- The optimal CC-IMT measurement protocol for predicting TOD and CVR (Framingham) is the mean of 120 measures.
- This protocol involves averaging mean values from near and far walls across all three projections of both carotid arteries.
- This standardized approach enhances the accuracy of cardiovascular risk assessment.
Background:
To assess which measurement of common carotid intima-media thickness (CC-IMT) is associated to a greater overall cardiovascular risk (CVR), and vascular cardiac and renal target organ damage (TOD), in diabetic, hypertensive patients and healthy subjects.
Methods:
A cross-sectional study, inclusion of 305 patients (113 hypertensive, 100 diabetics, and 92 healthy), aged 30-75 years.
Measurements:
Mean CC-IMT and maximum CC-IMT in near and far walls and in the anterior, lateral and posterior projections. Ankle/brachial index (ABI), pulse wave velocity (PWV), glomerular filtration rate (GFR), albumin/creatinine ratio, Cornell voltage-duration product (VDP) and CVR with the Framingham equation and the SCORE.
Results:
CC-IMT shows a positive correlation with CVR, PWV, and Cornell VDP, and a negative correlation with ABI and GFR (P < 0.001), with no difference between mean and maximum values, near and far wall, or projections. The odds ratio (OR) for the presence of TOD was greatest in mean CC-IMT (OR = 1.85 (95% confidence interval (CI): 1.335-2.58)) and lowest in maximum CC-IMT in the posterior projections OR = 1.42 (95% CI: 1.12-1.80). For each unit increase in mean CC-IMT, a risk increase by 1.98 may be expected (95% CI: 0.69-3.26), whereas the risk increase for each unit increase in maximum CC-IMT is 1.75 (95% CI: 0.70-2.79) (P < 0.001) with Framingham and with no significant association with SCORE.
Conclusions:
The CC-IMT measurement protocol best predicting for the occurrence of TOD and CVR estimated with Framingham is the mean of 120 measures of mean values in the near and far walls in all three projections of both carotid arteries.
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