Document Detail

Carotid-wall intima-media thickness and cardiovascular events.
MedLine Citation:
PMID:  21774709     Owner:  NLM     Status:  MEDLINE    
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.).
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:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The New England journal of medicine     Volume:  365     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-21     Completed Date:  2011-07-28     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  213-21     Citation Subset:  AIM; IM    
Department of Radiology, Tufts Medical Center, Boston, MA 02111, USA.
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MeSH Terms
Cardiovascular Diseases* / pathology
Carotid Artery, Common / anatomy & histology*,  ultrasonography
Cohort Studies
Kaplan-Meier Estimate
Middle Aged
Proportional Hazards Models
Risk Assessment*
Risk Factors
Tunica Intima / anatomy & histology*
Tunica Media / anatomy & histology*
Grant Support
Comment In:
N Engl J Med. 2011 Oct 27;365(17):1640; author reply 1641-2   [PMID:  22029988 ]
N Engl J Med. 2011 Oct 27;365(17):1640-1; author reply 1641-2   [PMID:  22029989 ]
J Neurol. 2011 Oct;258(10):1904-6   [PMID:  21932126 ]
N Engl J Med. 2011 Oct 27;365(17):1641; author reply 1641-2   [PMID:  22029990 ]

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