Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations?
OBJECTIVE
Measurement of change in carotid intima-media thickness (CIMT) has been proposed as an alternative for the occurrence of cardiovascular (CV) events in the assessment of therapeutic interventions. Nevertheless, criticism has been voiced based on observations indicating a weak relation between CIMT and coronary atherosclerosis as well as on the virtual absence of data showing that progression of CIMT indeed predicts coronary artery disease (CAD) and stroke.


RESULTS
We set out to review the evidence on these issues by performing a literature search on these topics. Of the 34 studies on the relation of CIMT with coronary atherosclerosis, as assessed by angiography (n=33) or intravascular ultrasound (n=1), 30 showed a modest positive relationship; the magnitude of which was similar to that found in autopsy studies. Of all studies on CIMT and future CV events (n=18), 17 showed graded positive relationships. At present, only one study has provided evidence on the relation of change in CIMT and future CV events, showing an increased risk with CIMT progression. The paucity of data on progression and future CV risk is partly attributable to time windows required to complete these studies.


CONCLUSIONS
The modest relation between CIMT and coronary atherosclerosis most likely reflects variability in atherosclerosis development between the vascular beds rather than limitations of CIMT measurements. Additional data on the relation between change in CIMT and future CV events is required and currently is in progress.
Bots
Michiel L
ML
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands, and Hopital Broussais Assistance Publique Hopitaux de Paris-Faculte de Medecine Rene Descartes, France. m.l.bots@umcutrecht.nl
Baldassarre
Damiano
D
Simon
Alain
A
de Groot
Eric
E
O'Leary
Daniel H
DH
Riley
Ward
W
Kastelein
John J
JJ
Grobbee
Diederick E
DE
D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000473:pathology*; D003324:Coronary Artery Disease / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000473:pathology; D017539:Tunica Intima / Q000473:pathology*; D017540:Tunica Media / Q000473:pathology*