Carotid intima-media thickness as a marker of cardiovascular risk in hypertensive patients with coronary artery disease.
BACKGROUND
The aim of this study was to examine the significance of ultrasound-measured carotid intima-media thickness (CIMT) in high-risk patients with hypertension and coronary artery disease (CAD), as an independent prognostic factor in determining the risk of all-cause death or future cardiovascular events.


METHODS
The study included 297 consecutive patients (mean age +/- SD, 57 +/- 9.4 years) with diagnosed hypertension and CAD, referred for coronary angiography. The mean of maximal CIMT in two arterial segments bilaterally was calculated. The primary endpoint was a patient's death from all causes. Death, stroke, or myocardial infarction comprised the secondary, composite endpoint.


RESULTS
There was a follow-up of 1 to 79 (mean, 41) months. The predictors of death in a multivariate Cox proportional hazards model were the number of stenosed coronary arteries (P = .007) and CIMT (P = .001). The risk of the secondary, composite endpoint (death, stroke, or myocardial infarction) was determined by diabetes (P = .008) and CIMT (P = .010). Nearly 99% of patients with "low CIMT" (< or =1.13 mm) survived for 5 years, versus 78% with "high CIMT" >1.13 mm (log-rank test; P < .001). For the secondary, composite endpoint (death, stroke, or myocardial infarction), the event-free survival rate was 95% (low CIMT), versus 74% after 5 years (high CIMT) (P < .008).


CONCLUSIONS
Intima-media thickness of the carotid arteries is a strong and independent predictor of death and serious cardiovascular events in hypertensive patients with CAD referred for coronary angiography.
Zielinski
Tomasz
T
Department of Heart Failure and Transplantation, Institute of Cardiology, Warsaw, Poland. tzielin@ikard.pl
Dzielinska
Zofia
Z
Januszewicz
Andrzej
A
Rynkun
Dariusz
D
Makowiecka Ciesla
Magdalena
M
Tyczynski
Pawel
P
Prejbisz
Aleksander
A
Demkow
Marcin
M
Kadziela
Jacek
J
Naruszewicz
Marek
M
Januszewicz
Magdalena
M
Juraszynski
Zbigniew
Z
Korewicki
Jerzy
J
Ruzyllo
Witold
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology*; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology*; D018616:Ultrasonography, Doppler, Duplex
D015415:Biomarkers