title: The relationship between carotid intima-media thickness and carotid plaque in the Northern Manhattan Study.
abstract: OBJECTIVE
  Carotid intima-media thickness (cIMT) and carotid plaque (CP) are proposed biomarkers of subclinical atherosclerosis associated with stroke risk. Whether cIMT and CP are distinct phenotypes or single traits at different stages of atherosclerotic development is unclear. We explored the relationship between these markers in the population-based Northern Manhattan Study.
  
  
  METHODS
  We used high-resolution ultrasound and validated imaging protocols to study the cross-sectional (N = 1788 stroke-free participants) and prospective relationship (N = 768 with follow-up scan; mean years between examinations = 3.5) between CP and cIMT measured in plaque-free areas.
  
  
  RESULTS
  The mean age was 66 ± 9 (40% male, 19% black, 17% white, 61% Hispanic). The mean baseline cIMT was 0.92 ± 0.09 mm, 0.94 ± 0.09 mm among the 58% with prevalent plaque, 0.90 ± 0.08 mm among the 42% without prevalent plaque (p < 0.0001). Each 0.1 mm increase in baseline cIMT was associated with a 1.72-fold increased odds of plaque presence (95%CI = 1.50-1.97), increased plaque thickness (effect on the median = 0.46 mm, p < 0.0001), and increased plaque area (effect on the median = 3.45 mm(2), p < 0.0001), adjusting for demographics and vascular risk factors. Elevated baseline cIMT was associated with an increased risk of new plaque in any location at follow-up, but after adjusting for demographics and vascular risk factors this association was no longer present. No association was observed in carotid segment-specific analyses.
  
  
  CONCLUSIONS
  Increased cIMT was associated with baseline prevalent plaque but did not predict incident plaque independent of other vascular risk factors. This finding suggests that increased cIMT is not an independent predictor of plaque development although these atherosclerotic phenotypes often coexist and share some common vascular determinants.
authors.affiliation: Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA. Electronic address: trundek@med.miami.edu.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.affiliation: Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA. Electronic address: hgardener@med.miami.edu.
authors.forename: Hannah
authors.initials: H
authors.lastname: Gardener
authors.affiliation: Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA; Department of Systems Medicine, School of Medicine, University of Rome 'Tor Vergata', Via Montpellier 1, 00133 Rome, Italy; IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Della-Morte
authors.affiliation: Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Chuanhui
authors.initials: C
authors.lastname: Dong
authors.affiliation: Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Digna
authors.initials: D
authors.lastname: Cabral
authors.affiliation: Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA; Department of Psychiatry, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tiozzo
authors.affiliation: Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Roberts
authors.affiliation: Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Karolinska University Hospital Huddinge, 14186 Stockholm, Sweden.
authors.forename: Milita
authors.initials: M
authors.lastname: Crisby
authors.affiliation: Department of Biostatistics, Mailman Public School of Health, Columbia University, New York, NY, USA.
authors.forename: Kuen
authors.initials: K
authors.lastname: Cheung
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Demmer
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA; Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Centre de Recherches Epidemiologies et Biostatistique, INSERM U1153, Paris, France.
authors.forename: Moise
authors.initials: M
authors.lastname: Desvarieux
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000208:ethnology; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Atherosclerosis; Carotid artery; Carotid intima media thickness; Carotid plaque; Carotid ultrasound