title: Associations of risk factors with segment-specific intimal-medial thickness of the extracranial carotid artery.
abstract: OBJECTIVE
  It is generally assumed that risk factors affect extracranial carotid intimal-medial thickness similarly among all arterial segments. This assumption underlies use of single segments or walls of segments as outcome variables for risk factor studies and clinical trials. However, if the impact of risk factors was unequal for various segments or circumferentially asymmetrical within segments, then inferences drawn from a single segment or wall might not be generalizable; furthermore, since individual segments and walls have unique histological characteristics and are differentially exposed to turbulent flow, risk factor relationships with a particular segment or wall may provide inferences regarding pathogenesis of atherosclerosis.
  
  
  METHODS
  We evaluated associations of risk factors with intimal-medial thickness at the near and far walls of the common carotid artery, bifurcation, and internal carotid artery in 280 individuals older than 45 years equally divided between coronary artery disease cases and controls and between men and women.
  
  
  RESULTS
  The patterns of differences in mean intimal-medial thickness among segments vary, depending on age, history of hypertension, body mass index in women, and coronary (case-control) status. The asymmetry of disease depended on blood glucose concentrations, prior history of diabetes, smoking, and coronary status. Sex, postmenopausal status, LDL cholesterol, systolic blood pressure, and history of myocardial infarction all had statistically significant relationships with intimal-medial thickness that were fairly homogeneous among arterial sites.
  
  
  CONCLUSIONS
  Focus on an individual segments or walls of the extracranial carotid arteries may lead to overestimation or underestimation of associations of risk factors with extracranial carotid intimal-medial thickness.
authors.affiliation: Departments of Public Health Sciences, Vascular Ultrasound Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Espeland
authors.forename: R
authors.initials: R
authors.lastname: Tang
authors.forename: J G
authors.initials: JG
authors.lastname: Terry
authors.forename: D H
authors.initials: DH
authors.lastname: Davis
authors.forename: M
authors.initials: M
authors.lastname: Mercuri
authors.forename: J R
authors.initials: JR
authors.lastname: Crouse
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D017540:Tunica Media / Q000473:pathology; D014463:Ultrasonography