title: Combining carotid intima-media thickness with carotid plaque on screening for coronary heart disease.
abstract: BACKGROUND
  Ultrasound-detected carotid artery intima-media thickness (IMT) and carotid plaque are possible screening tests for coronary heart disease (CHD) among asymptomatic individuals.
  
  
  OBJECTIVE
  To assess the increase in screening performance of combining carotid IMT and plaque compared with each measurement alone in the identification of individuals with CHD.
  
  
  METHODS
  Ultrasound examination of left and right carotid arteries was performed on 100 individuals (median age 57), 55 with a history of CHD (unstable angina or myocardial infarction) and 45 without. IMT measurements were taken from the common carotid artery and plaque was identified above, at and below the carotid bifurcation. Associations between IMT and plaque were determined using logistic regression, and screening performance was assessed from the distributions of IMT and plaque among cases and controls.
  
  
  RESULTS
  At a false-positive rate of 5%, IMT (cut-off >0.75 mm) identified 30% (95% CI 14-58) of affected individuals. There was an increase in the detection rate of 8 percentage points (1-33%) using IMT and plaque combined compared with IMT alone. As the false-positive increased, the difference in the detection rate increased, up to a maximum of 20 percentage points (5-38%) at a false-positive rate of 20%. The comparison of IMT and plaque combined with plaque alone could only be estimated for the false-positive rate observed using plaque alone (18%); at this point the detection rate was 72% for plaque and 75% for plaque and IMT combined, an increase of 3 percentage points (0-4%).
  
  
  CONCLUSIONS
  In screening for CHD, combining carotid IMT measurement with plaque assessment is better than using either measurement alone, but the improvement in discrimination is not sufficient to make carotid ultrasound screening for CHD worthwhile.
authors.affiliation: Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, London, UK. d.s.wald@qmul.ac.uk
authors.forename: David S
authors.initials: DS
authors.lastname: Wald
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Bestwick
authors.forename: Geraint
authors.initials: G
authors.lastname: Morton
authors.forename: Linda
authors.initials: L
authors.lastname: Drummond
authors.forename: Nick
authors.initials: N
authors.lastname: Jenkins
authors.forename: Pouran
authors.initials: P
authors.lastname: Khodabakhsh
authors.forename: Nick P
authors.initials: NP
authors.lastname: Curzen
mesh_terms: D000328:Adult; D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014463:Ultrasonography