title: Measurement of carotid artery intima-media thickness in dyslipidemic patients increases the power of traditional risk factors to predict cardiovascular events.
abstract: A longitudinal observational study investigated whether the measurement, in clinical practice, of carotid maximum intima-media thickness (Max-IMT) could be combined with the Framingham risk score (FRS) to improve the predictability of cardiovascular events in dyslipidemic patients who are at low or intermediate risk. Max-IMT was measured by ultrasound in 1969 patients attending a lipid clinic. The "best threshold values" (BTVs) above which we considered the Max-IMT to be abnormally high were calculated for our dyslipdemic population for each 10-year age interval in men and women. Two hundred and forty-two patients (age 54+/-10 years; 43.8% women) with an FRS <20%, i.e. at low or intermediate risk, were monitored for more than 5 years. Twenty-four of these patients suffered a cardiovascular event within 5.1+/-2.3 years. Both FRS and Max-IMT proved to be independent outcome predictors (p<0.04, both), with a hazard ratio (HR) of 6.7 (95% CI 1.43, 31.04; p=0.015) in patients in whom FRS was 10-20% and Max-IMT was above the BTV (60th percentile of Max-IMT distribution for men or 80th for women). In Kaplan-Meier analysis, the Max-IMT significantly improved the predictive value of the FRS (chi(2)=8.13, p=0.04). Patients with FRS 10-20% (currently considered intermediate-risk) and also elevated Max-IMT values came into the same high-risk category as patients with FRS 20-30%. The combination of FRS with Max-IMT measurement can be used in routine clinical practice to greatly enhance the predictability of cardiovascular events in the large number of patients who fall into the intermediate-risk category, which currently does not call for aggressive preventive measures.
authors: University Centre for Dyslipidemia (Niguarda Hospital), Department of Pharmacological Sciences, University of Milan, Italy. damiano.baldassarre@unimi.it
authors: Damiano
authors: D
authors: Baldassarre
authors: Mauro
authors: M
authors: Amato
authors: Linda
authors: L
authors: Pustina
authors: Samuela
authors: S
authors: Castelnuovo
authors: Silvia
authors: S
authors: Sanvito
authors: Lorenzo
authors: L
authors: Gerosa
authors: Fabrizio
authors: F
authors: Veglia
authors: Shlomo
authors: S
authors: Keidar
authors: Elena
authors: E
authors: Tremoli
authors: Cesare R
authors: CR
authors: Sirtori