title: Effect of comprehensive cardiovascular disease risk management on longitudinal changes in carotid artery intima-media thickness in a community-based prevention clinic.
abstract: BACKGROUND
  The aim of the study was to examine changes in carotid intima-media thickness (CIMT) and carotid plaque morphology in patients receiving multifactorial cardiovascular disease (CVD) risk factor management in a community-based prevention clinic. Quantitative changes in CIMT and qualitative changes in carotid plaque morphology may be measured non-invasively by ultrasound.
  
  
  METHODS
  This is a retrospective study on a cohort of 324 patients who received multifactorial cardiovascular risk reduction treatment at a community prevention clinic. All patients received lipid-lowering medications (statin, niacin, and/or ezetimibe) and lifestyle modification. All patients underwent at least one follow-up CIMT measurement after starting their regimen. Annual biomarker, CIMT, and plaque measurements were analyzed for associations with CVD risk reduction treatment.
  
  
  RESULTS
  Median time to last CIMT was 3.0 years. Compared to baseline, follow-up analysis of all treatment groups at 2 years showed a 52.7% decrease in max CIMT, a 3.0% decrease in mean CIMT, and an 87.0% decrease in the difference between max and mean CIMT (p < 0.001). Plaque composition changes occurred, including a decrease in lipid-rich plaques of 78.4% within the first 2 years (p < 0.001). After the first 2 years, CIMT and lipid-rich plaques continued to decline at reduced rates.
  
  
  CONCLUSIONS
  In a cohort of patients receiving comprehensive CVD risk reduction therapy, delipidation of subclinical carotid plaque and reductions in CIMT predominantly occurred within 2 years, and correlated with changes in traditional biomarkers. These observations, generated from existing clinical data, provide unique insight into the longitudinal on-treatment changes in carotid plaque.
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA.
authors.forename: Henry G
authors.initials: HG
authors.lastname: Cheng
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA.
authors.forename: Birju S
authors.initials: BS
authors.lastname: Patel
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA.
authors.forename: Seth S
authors.initials: SS
authors.lastname: Martin
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Blaha
authors.affiliation: Heart Attack and Stroke Prevention Center, Spokane, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Doneen
authors.affiliation: Heart Attack and Stroke Prevention Center, Spokane, USA.
authors.forename: Brad
authors.initials: B
authors.lastname: Bale
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Jones
keywords: cardiovascular disease; carotid intima-media thickness; cholesterol; lipid; statin; vascular disease