title: The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis.
abstract: BACKGROUND
  Carotid artery plaques are associated with coronary artery atherosclerotic lesions. We evaluated various ultrasound definitions of carotid artery plaque as predictors of future cardiovascular disease (CVD) and coronary heart disease (CHD) events.
  
  
  RESULTS
  We studied the risk factors and ultrasound measurements of the carotid arteries at baseline of 6562 members (mean age 61.1 years; 52.6% women) of the Multi-Ethnic Study of Atherosclerosis (MESA). ICA lesions were defined subjectively as >0% or ≥25% diameter narrowing, as continuous intima-media thickness (IMT) measurements (maximum IMT or the mean of the maximum IMT of 6 images) and using a 1.5-mm IMT cut point. Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CHD, and stroke. Harrell's C-statistics, Net Reclassification Improvement, and Integrated Discrimination Improvement were used to evaluate the incremental predictive value of plaque metrics. At 7.8-year mean follow-up, all plaque metrics significantly predicted CVD events (n=515) when added to Framingham risk factors. All except 1 metric improved the prediction of CHD (by C-statistic, Net Reclassification Improvement, and Integrated Discrimination Improvement. Mean of the maximum IMT had the highest NRI (7.0%; P=0.0003) with risk ratio of 1.43/mm; 95% CI 1.26-1.63) followed by maximum IMT with an NRI of 6.8% and risk ratio of 1.27 (95% CI 1.18-1.38).
  
  
  CONCLUSIONS
  Ultrasound-derived plaque metrics independently predict cardiovascular events in our cohort and improve risk prediction for CHD events when added to Framingham risk factors.
authors.affiliation: Ultrasound Reading Center, Department of Radiology, Tufts Medical Center, Boston, MA 02111, USA. jpolak@tuftsmedicalcenter.org
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Anna E H
authors.initials: AE
authors.lastname: Zavodni
authors.forename: Daniel H
authors.initials: DH
authors.lastname: O'Leary
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality