title: Carotid intima-media thickness value distributions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: OBJECTIVE
  Carotid intima-media thickness (IMT) is a noninvasive measurement of early atherosclerosis. Most IMT studies have involved populations with low rates of racial blending. The aim of the present article is to describe IMT value distributions and analyze the influence of sex and race on IMT values in a large Brazilian sample, a setting with a high rate of racial admixture.
  
  
  METHODS
  The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort of 15,105 adult (aged 35-74 years) civil servants in six Brazilian cities. Baseline assessment included IMT measurements in both common carotid arteries. Race was self-reported. We studied the association between sex and race with IMT values using multiple linear regression models. We conducted analyses in all and low-risk individuals, defined as those without classical cardiovascular risk factors.
  
  
  RESULTS
  We analyzed complete IMT data from 10,405 ELSA-Brasil participants. We present nomograms by age for all and low-risk individuals, stratified by sex and race. We found that men had significantly higher maximal IMT values compared with women (β = 0.058; P < 0.001). This association remained for low-risk individuals (β = 0.027; P = 0.001). In addition, Brown and White individuals had lower maximal IMT values compared with Black individuals for all (β = -0.034 and β = -0.054, respectively; P < 0.001) and low-risk individuals (β = -0.027; P = 0.013 and β = -0.035; P < 0.001, respectively).
  
  
  CONCLUSIONS
  We found significantly higher IMT values in men. We found significantly higher IMT values in Black individuals than White and Brown individuals. These results persisted when analyses were restricted to low-risk individuals.
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil. Electronic address: itamarss@usp.br.
authors.forename: Itamar S
authors.initials: IS
authors.lastname: Santos
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Márcio S
authors.initials: MS
authors.lastname: Bittencourt
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Ilka R S
authors.initials: IR
authors.lastname: Oliveira
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Angelita G
authors.initials: AG
authors.lastname: Souza
authors.affiliation: Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Danilo P
authors.initials: DP
authors.lastname: Meireles
authors.affiliation: Departments of Neurology and Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Murilo
authors.initials: M
authors.lastname: Foppa
authors.affiliation: Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Bezerra
authors.affiliation: Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Cláudia M V
authors.initials: CM
authors.lastname: Freire
authors.affiliation: Universidade Federal do Espirito Santo, Vitoria, Brazil.
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Roelke
authors.affiliation: Universidade Federal da Bahia, Salvador, Bahia, Brazil.
authors.forename: Sayonara
authors.initials: S
authors.lastname: Carrilho
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Benseñor
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D044383:Black People; D001938:Brazil; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology; D017536:Carotid Artery, Common / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D005006:Ethnicity; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors; D044465:White People
keywords: Atherosclerosis; Cross-sectional analysis; Intima–media thickness; Nomogram; Race