Carotid intima media thickness and plaques can predict the occurrence of ischemic cerebrovascular events.
OBJECTIVE
The clinical usefulness of noninvasive measurement of carotid intima media thickness and plaque visualization in the general population is still uncertain.


METHODS
We evaluated the age-specific incidence rates of cerebrovascular events in a cohort of 1348 subjects randomly taken from the census list of San Daniele Township and followed for a mean period of 12.7 years. The association among common carotid intima media thickness, measured at baseline, arterial risk factors, and incidence of ischemic cerebrovascular events was modeled using Poisson regression. The predictive ability of common carotid intima media thickness over arterial risk factors (summarized in the Framingham Stroke Risk Score) was evaluated by receiver operating characteristic curve analysis.


RESULTS
During the follow-up, 115 subjects developed nonfatal ischemic stroke, transient ischemic attack, or vascular death, which were the predefined study end points. After adjustment for age and sex, hypertension, diabetes, common carotid intima media thickness above 1 mm, and carotid plaques were all independent risk factors for development of vascular events. Inclusion of carotid findings (presence of common carotid intima media thickness above 1 mm or carotid plaques) resulted in a predictive power higher than Framingham Stroke Risk Score alone only on for those subjects with a Framingham Stroke Risk Score over 20%.


CONCLUSIONS
Although common carotid intima media thickness and presence of carotid plaques are known to be risk factors for the development of vascular events and to be independent from the conventional risk factors summarized in the Framingham Stroke Risk Score, their contribution to individual risk prediction is limited. Further studies will be required to address the role of carotid ultrasonography in the primary prevention of high-risk subjects.
Prati
Patrizio
P
Neurology Department, Gervasutta Hospital, Via Gervasutta 48, ASS n degrees 4 "Medio Friuli," 33100 Udine, Italy. patrizio.prati@tin.it
Tosetto
Alberto
A
Vanuzzo
Diego
D
Bader
Giovanni
G
Casaroli
Marco
M
Canciani
Luigi
L
Castellani
Sergio
S
Touboul
Pierre-Jean
PJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging* / Q000473:pathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D014463:Ultrasonography