title: Carotid intima-media thickness in plaque-free site, carotid plaques and coronary heart disease risk prediction in older adults. The Three-City Study.
abstract: OBJECTIVE
  We sought to address the respective association between carotid intima-media thickness (IMT) in plaque-free sites and plaques with coronary heart disease (CHD) and their usefulness for CHD risk prediction in the Three-City Study.
  
  
  METHODS
  At baseline, 5895 CHD-free adults aged 65-85 years underwent a bilateral ultrasound examination of carotid arteries. Mean IMT was measured in the far wall of the right and left common carotid arteries (CCA) at plaque-free site while the presence of focal plaques was assessed in the near and the far walls of the CCAs, the bifurcations and the origin of the internal carotid arteries.
  
  
  RESULTS
  After a median follow-up of 5.4 years, 223 subjects had a first ever CHD event. In multivariate analysis, carotid plaques were independent predictors of CHD (Hazard ratio (HR)(plaques at 1 site) = 1.5; 95% confidence interval (CI) = 1.0-2.2; HR(plaques at ≥ 2 sites) = 2.2; 95% CI = 1.6-3.1; p(for trend) < 0.001), contrary to mean CCA-IMT (HR(fifth vs.first quintile) = 0.8; 95% CI = 0.5-1.2; p(for trend) < 0.48). Adding carotid plaques to conventional risk factors significantly improved CHD risk prediction as measured by the area under the ROC curve (from 0.728 to 0.745; p = 0.04), the Harrell's c (from 0.748 to 0.762; p < 0.001), and the integrated discrimination improvement (IDI = 0.007; p = 0.002)/net reclassification improvement (NRI = 13.7%; p < 0.001) indices.
  
  
  CONCLUSIONS
  Carotid plaques, but not CCA-IMT measured at a plaque-free site, were independent predictors of CHD and improved CHD risk prediction in older adults.
authors: Inserm, U970, Paris Cardiovascular Research Centre, PARCC, University Paris Descartes, UMR-S970, Paris, France. matthieu.plichart@inserm.fr
authors: Matthieu
authors: M
authors: Plichart
authors: David S
authors: DS
authors: Celermajer
authors: Mahmoud
authors: M
authors: Zureik
authors: Catherine
authors: C
authors: Helmer
authors: Xavier
authors: X
authors: Jouven
authors: Karen
authors: K
authors: Ritchie
authors: Christophe
authors: C
authors: Tzourio
authors: Pierre
authors: P
authors: Ducimetière
authors: Jean-Philippe
authors: JP
authors: Empana
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology*; D016002:Discriminant Analysis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014463:Ultrasonography