| Carotid-wall intima-media thickness and cardiovascular events. | |
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MedLine Citation:
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PMID: 21774709 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Intima-media thickness of the walls of the common carotid artery and internal carotid artery may add to the Framingham risk score for predicting cardiovascular events. METHODS: We measured the mean intima-media thickness of the common carotid artery and the maximum intima-media thickness of the internal carotid artery in 2965 members of the Framingham Offspring Study cohort. Cardiovascular-disease outcomes were evaluated for an average follow-up of 7.2 years. Multivariable Cox proportional-hazards models were generated for intima-media thickness and risk factors. We evaluated the reclassification of cardiovascular disease on the basis of the 8-year Framingham risk score category (low, intermediate, or high) after adding intima-media thickness values. RESULTS: A total of 296 participants had a cardiovascular event. The risk factors of the Framingham risk score predicted these events, with a C statistic of 0.748 (95% confidence interval [CI], 0.719 to 0.776). The adjusted hazard ratio for cardiovascular disease with a 1-SD increase in the mean intima-media thickness of the common carotid artery was 1.13 (95% CI, 1.02 to 1.24), with a nonsignificant change in the C statistic of 0.003 (95% CI, 0.000 to 0.007); the corresponding hazard ratio for the maximum intima-media thickness of the internal carotid artery was 1.21 (95% CI, 1.13 to 1.29), with a modest increase in the C statistic of 0.009 (95% CI, 0.003 to 0.016). The net reclassification index increased significantly after addition of intima-media thickness of the internal carotid artery (7.6%, P<0.001) but not intima-media thickness of the common carotid artery (0.0%, P=0.99). With the presence of plaque, defined as intima-media thickness of the internal carotid artery of more than 1.5 mm, the net reclassification index was 7.3% (P=0.01), with an increase in the C statistic of 0.014 (95% CI, 0.003 to 0.025). CONCLUSIONS: The maximum internal and mean common carotid-artery intima-media thicknesses both predict cardiovascular outcomes, but only the maximum intima-media thickness of (and presence of plaque in) the internal carotid artery significantly (albeit modestly) improves the classification of risk of cardiovascular disease in the Framingham Offspring Study cohort. (Funded by the National Heart, Lung, and Blood Institute.). |
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Authors:
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Joseph F Polak; Michael J Pencina; Karol M Pencina; Christopher J O'Donnell; Philip A Wolf; Ralph B D'Agostino |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: The New England journal of medicine Volume: 365 ISSN: 1533-4406 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-07-21 Completed Date: 2011-07-28 Revised Date: 2012-01-24 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: United States |
Other Details:
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Languages: eng Pagination: 213-21 Citation Subset: AIM; IM |
Affiliation:
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Department of Radiology, Tufts Medical Center, Boston, MA 02111, USA. jpolak@tuftsmedicalcenter.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiovascular Diseases* / pathology Carotid Artery, Common / anatomy & histology*, ultrasonography Cohort Studies Female Humans Kaplan-Meier Estimate Male Middle Aged Probability Proportional Hazards Models Risk Assessment* Risk Factors Tunica Intima / anatomy & histology* Tunica Media / anatomy & histology* |
| Grant Support | |
ID/Acronym/Agency:
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HL081352/HL/NHLBI NIH HHS; N01 HC025195/HC/NHLBI NIH HHS; N01-HC-25195/HC/NHLBI NIH HHS; R01 HL069003/HL/NHLBI NIH HHS; R01 HL069003-05/HL/NHLBI NIH HHS; R01 HL081352-05/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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J Neurol. 2011 Oct;258(10):1904-6
[PMID:
21932126
]
N Engl J Med. 2011 Oct 27;365(17):1640-1; author reply 1641-2 [PMID: 22029989 ] N Engl J Med. 2011 Oct 27;365(17):1641; author reply 1641-2 [PMID: 22029990 ] N Engl J Med. 2011 Oct 27;365(17):1640; author reply 1641-2 [PMID: 22029988 ] |
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