title: Progression of carotid plaque volume predicts cardiovascular events.
abstract: OBJECTIVE
  Carotid ultrasound evaluation of intima-media thickness (IMT) and plaque burden has been used for risk stratification and for evaluation of antiatherosclerotic therapies. Increasing evidence indicates that measuring plaque burden is superior to measuring IMT for both purposes. We compared progression/regression of IMT, total plaque area (TPA), and total plaque volume (TPV) as predictors of cardiovascular outcomes.
  
  
  METHODS
  IMT, TPA, and TPV were measured at baseline in 349 patients attending vascular prevention clinics; they had TPA of 40 to 600 mm(2) at baseline to qualify for enrollment. Participants were followed up for ≤5 years (median, 3.17 years) to ascertain vascular death, myocardial infarction, stroke, and transient ischemic attacks. Follow-up measurements 1 year later were available in 323 cases for IMT and TPA, and in 306 for TPV.
  
  
  RESULTS
  Progression of TPV predicted stroke, death or TIA (Kaplan-Meier logrank P=0.001), stroke/death/MI (P=0.008) and Stroke/Death/TIA/Myocardial infarction (any Cardiovascular event) (P=0.001). Progression of TPA weakly predicted Stroke/Death/TIA (P=0.097) but not stroke/death/MI (P=0.59) or any CV event (P=0.143); likewise change in IMT did not predict Stroke/Death/MI (P=0.13) or any CV event (P=0.455 ). In Cox regression, TPV progression remained a significant predictor of events after adjustment for coronary risk factors (P=0.001) but change in TPA did not. IMT change predicted events in an inverse manner; regression of IMT predicted events (P=0.004).
  
  
  CONCLUSIONS
  For assessment of response to antiatherosclerotic therapy, measurement of TPV is superior to both IMT and TPA.
authors.affiliation: Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Canada.
authors.forename: Thapat
authors.initials: T
authors.lastname: Wannarong
authors.forename: Grace
authors.initials: G
authors.lastname: Parraga
authors.forename: Daniel
authors.initials: D
authors.lastname: Buchanan
authors.forename: Aaron
authors.initials: A
authors.lastname: Fenster
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Hackam
authors.forename: J David
authors.initials: JD
authors.lastname: Spence
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness / Q000295:instrumentation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging*
keywords: Carotid; IMT; Myocardial infarction; Risk; Stroke; Ultrasound; plaque