Thickening of the carotid wall. A marker for atherosclerosis in the elderly? Cardiovascular Health Study Collaborative Research Group.
OBJECTIVE
We investigated the relationships between prevalent coronary heart disease (CHD), clinically manifest atherosclerotic disease (ASD), and major established risk factors for atherosclerosis and intima-media thickness (IMT) in the common carotid arteries (CCA) and internal carotid arteries (ICA) separately and in combination in older adults. We wished to determine whether a noninvasive measurement can serve as an indicator of clinically manifest atherosclerotic disease and to determine which of the two variables, CCA IMT or ICA IMT, is a better correlate.


METHODS
IMT of the CCA and ICA was measured with duplex ultrasound in 5117 of 5201 individuals enrolled in the Cardiovascular Health Study, a study of the risk factors and the natural history of cardiovascular disease in adults aged 65 years or more. Histories of CHD, peripheral arterial disease, and cerebrovascular disease were obtained during baseline examination. Risk factors included cholesterol levels, cigarette smoking, elevated blood pressure, diabetes, age, and sex. Relationships between risk factors and IMT were studied by multiple regression analysis and canonical variate analysis. Prediction of prevalent CHD and ASD by IMT measurements in CCAs and ICAs were made by logistic regression, adjusting for age and sex.


RESULTS
IMT measurements of the CCAs and ICAs were greater in persons with CHD and ASD than those without, even after controlling for sex (P < .001). IMT measurements in the ICA were greater than those in the CCA. Risk factors for ASD accounted for 17% and 18% of the variability in IMT in the CCA and ICA, respectively. These same risk factors accounted for 25% of the variability of a composite measurement consisting of the sum of the ICA IMT and CCA IMT. The ability to predict CHD and ASD was greater for ICA IMT (odds ratio [confidence interval]: 1.36 [1.31 to 1.41] and 1.35 [1.25 to 1.44], respectively) than for CCA IMT (1.09 [1.05 to 1.13] and 1.17 [1.09 to 1.25]).


CONCLUSIONS
Whereas CCA IMT is associated with major risk factors for atherosclerosis and existing CHD and ASD in older adults, this association is not as strong as that for ICA IMT. The combination of these measures relates more strongly to existing CHD and ASD and cerebrovascular disease risk factors than either taken alone.
O'Leary
D H
DH
Department of Radiology, Tufts-New England Medical Center, Boston, Mass 02111, USA.
Polak
J F
JF
Kronmal
R A
RA
Savage
P J
PJ
Borhani
N O
NO
Kittner
S J
SJ
Tracy
R
R
Gardin
J M
JM
Price
T R
TR
Furberg
C D
CD
D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000453:epidemiology* / Q000473:pathology*; D001794:Blood Pressure; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012727:Sex Characteristics; D012907:Smoking; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D014463:Ultrasonography
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL