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Intima-media thickness in carotid artery predicted CV outcomes
Polak J. N Engl J Med. 2011;365:213-221.
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Intima-media thickness of the common and internal carotid artery was an independent predictor of CV events, according to an analysis of the Framingham Offspring Study.
The study also found that maximum intima-media thickness had significant, although modest, predictive power of the risk factors and also benefited risk classification.
In all, 2,965 participants (mean age, 58 years; 55% women) who had no history of CVD were included in the analysis.
During a mean follow-up of 7.2 years, 10% of the population experienced a CV event, including events related to CHD, peripheral arterial disease, stroke and HF, which was predicted by risk factors of the Framingham risk score. With every 1 standard deviation increase in intima-media thickness of the common carotid artery, the adjusted HR for CVD was 1.13 (95% CI, 1.02-1.24), whereas the HR for the maximum intima-media thickness was more pronounced (1.21; 95% CI, 1.13-1.29).
Additionally, the researchers reported that the net reclassification index rose significantly after the addition of intima-media thickness of the internal carotid artery (P<.001) but not the common carotid artery (P=.99).
“Our results show that plaque in the internal carotid artery, either measured as part of the continuous intima-media thickness or assumed to be present if the thickness exceeds a set point of 1.5 mm, offers modest incremental value to the Framingham risk score in predicting CV events,” they concluded. “We believe the intima-media thickness of the internal carotid artery should be measured in addition to the thickness of the common carotid artery for purposes of CV risk assessment.”
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Polak et al continue to provide important insights into the impact of carotid intima-media thickness on CV risk. In this large cohort followed prospectively, the impact of carotid intima-media thickness was only helpful in addition to the Framingham Risk Score using internal carotid artery intima-media thickness measurements. This is interesting, as several previous publications have suggested that the common carotid artery intima-media thickness values are of equal predictive value in determining CV risk. Although the Framingham Risk Score performed well in determining future CV risk, adding increase in internal carotid artery intima-media thickness can help in further assessing future CV risk.
Michael Jaff, DO
Cardiology Today
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