Early carotid atherosclerosis in healthy middle-aged women. A follow-up study

Few longitudinal data about early atherosclerotic lesions of the carotid arteries are available in general populations. The main purpose of this study was to investigate risk factors for development and regression of intimal-medial thickening and atheromatous plaques.

Initial and 2-year examinations of the carotid arteries with high-resolution B-mode ultrasonography were performed in 308 apparently healthy women aged 45 to 55 years. The development of new atheromatous plaques and new intimal-medial thickening and the disappearance of preexisting plaques and intimal-medial thickening defined the four outcomes of interest.

The development of plaques occurred more frequently in women with intimal-medial thickening than in women with normal carotid arteries at baseline (14.4% versus 7.2%, P < .053). A regression was seen in 21.7% of the women with preexisting plaques. Development of intimal-medial thickening occurred in 47.5% of the women with normal carotid arteries whereas 20.2% of the women with preexisting intimal-medial thickening showed a regression of their lesions. Multiple logistic regression showed that smoking (regression coefficient +/- SE: 1.281 +/- 0.450; P < .005), baseline levels of systolic blood pressure (regression coefficient +/- SE: 0.031 +/- 0.015; P < .04) and apolipoprotein B (regression coefficient +/- SE: 0.016 +/- 0.007; P < .03) were independently associated with the development of plaques, whereas the presence of an intimal-medial thickening did not reach the significance level (regression coefficient +/- SE: 0.639 +/- 0.436; P < .15). Independent predictors of the development of intimal-medial thickening were age (regression coefficient +/- SE: 0.124 +/- 0.048; P < .04) and, with a borderline significance level, (log)triglycerides (regression coefficient +/- SE: 0.854 +/- 0.451; P < .06). Low levels of low-density lipoprotein cholesterol (regression coefficient +/- SE: 0.027 +/- 0.009; P < .004) were associated with its regression.

This longitudinal study emphasizes the interest of B-mode ultrasonography in the monitoring of early carotid lesions. It gives further support to the hypothesis that intimal-medial thickening may be an early indicator of the atherosclerotic process.