Risk factors for the progression of carotid intima-media thickness over a 16-year follow-up period: the Malmö Diet and Cancer Study.
OBJECTIVE
To evaluate the progression of carotid intima-media thickness (IMT) in the common carotid artery (CCA) and the bifurcation over a mean follow-up of 16 years in relation to cardiovascular risk factors.


METHODS
The study population included 3426 middle-aged Swedish men and women participating in the 1991-1994 (baseline) and the 2007-2012 (re-examination) investigation of the cardiovascular cohort of the Malmö Diet and Cancer Study (MDCS).


RESULTS
There were differences in risk factor patterns in arterial segments in that diabetes and male sex were associated with the progression of IMT in the bifurcation, but not in the CCA, and high-density lipoprotein cholesterol (HDL) was associated with the progression of IMT in the CCA, but not in the bifurcation. Favourable changes in systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL) and HDL during follow-up decreased the IMT progression rate in the CCA. There was a cumulative relationship between traditional cardiovascular risk factors (i.e., regular smoking, LDL/HDL-ratio ≥ 3, hypertension) and IMT progression rates. The odds ratio (OR) of high IMT CCA progression rate (>75th percentile) was 1.0 (reference), 1.4 (95% CI: 1.1, 1.7), 1.7 (95% CI: 1.3, 2.2) and 2.1 (95% CI: 1.4, 3.1), respectively, for individuals with none, one, two, and three risk factors.


CONCLUSIONS
There were differences in the associations between risk factors and progression rate in different arterial segments. Favourable changes in SBP and lipids during the follow-up period were associated with reduced IMT progression rates in the CCA.
Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden. Electronic address: Maria.rosvall@med.lu.se.
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Rosvall
Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden. Electronic address: Margaretha.M.Persson@skane.se.
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Persson
Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden. Electronic address: Gerd.ostling@med.lu.se.
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Östling
Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden. Electronic address: Peter.nilsson@med.lu.se.
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Nilsson
Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden. Electronic address: Olle.melander@med.lu.se.
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Melander
Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden. Electronic address: Bo.hedblad@med.lu.se.
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Hedblad
Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden. Electronic address: Gunnar.engstrom@med.lu.se.
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Engström
D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D018450:Disease Progression; D050171:Dyslipidemias / Q000097:blood / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D016014:Linear Models; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D065840:Protective Factors; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
D015415:Biomarkers; D008055:Lipids
Atherosclerosis; Carotid arteries; Epidemiology; Intima-media thickness; Risk factors; Ultrasound