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      Common Carotid Intima-Media Thickness and Risk of Stroke and Myocardial Infarction : The Rotterdam Study

      1 , 1 , 1 , 1 , 1

      Circulation

      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Noninvasive assessment of intima-media thickness (IMT) is widely used in observational studies and trials as an intermediate or proxy end point for cardiovascular disease. However, data showing that IMT predicts cardiovascular disease are limited. We studied whether common carotid IMT is related to future stroke and myocardial infarction. We used a nested case-control approach among 7983 subjects aged > or =55 years participating in the Rotterdam Study. At baseline (March 1990 through July 1993), ultrasound images of the common carotid artery were stored on videotape. Determination of incident myocardial infarction and stroke was predominantly based on hospital discharge records. Analysis (logistic regression) was based on 98 myocardial infarctions and 95 strokes that were registered before December 31, 1994. IMT was measured from videotape for all case subjects and a sample of 1373 subjects who remained free from myocardial infarction and stroke during follow-up. The mean duration of follow-up was 2.7 years. Results were adjusted for age and sex. Stroke risk increased gradually with increasing IMT. The odds ratio for stroke per standard deviation increase (0.163 mm) was 1.41 (95% CI, 1.25 to 1.82). For myocardial infarction, an odds ratio of 1.43 (95% CI, 1.16 to 1.78) was found. When subjects with a previous myocardial infarction or stroke were excluded, odds ratios were 1.57 (95% CI, 1.27 to 1.94) for stroke and 1.51 (95% CI, 1.18 to 1.92) for myocardial infarction. Additional adjustment for several cardiovascular risk factors attenuated these associations: 1.34 (95% CI, 1.08 to 1.67) and 1.25 (95% CI, 0.98 to 1.58), respectively. The present study, based on a short follow-up period, provides evidence that an increased common carotid IMT is associated with future cerebrovascular and cardiovascular events.

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          Most cited references 10

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          Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study.

          To assess whether carotid atherosclerosis measured by B-mode ultrasound is related to cardiovascular risk factors, 386 cases with carotid artery wall thickening and an equal number of controls free of arterial intima-media thickening were drawn from the cohort of the Atherosclerosis Risk in Communities (ARIC) Study examined in four communities in the United States between 1988 and 1990. Cases and controls were individually matched on sex, race, age group, study center, and date of examination. The mean values of total cholesterol, low density lipoprotein (LDL) cholesterol, total triglyceride, blood pressure, and pack-years of cigarette smoking were higher in cases than controls. Mean high density lipoprotein (HDL) cholesterol was lower in cases than controls. Case-control differences were all statistically significant. Multivariable-adjusted odds ratios point to differences of considerable magnitude in the risk of carotid atherosclerosis between groups defined by clinical and public health-oriented risk factor cut-points.
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            Carotid artery intima-media thickness as an indicator of generalized atherosclerosis.

             M Bots,  D. Grobbee (1994)
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              Ultrasound measurement of wall thickness in the carotid artery: fundamental principles and description of a computerized analysing system.

              A B-mode [two-dimensional (2D)] image from the carotid artery may be described as containing seven echo zones. The aim of the present work is to discuss how lumen diameter and wall thickness can be measured from these zones, and to review some of the basic principles of ultrasound physics and imaging. Simple experiments were performed to identify the echoes defining intima-lumen interfaces. The results showed that: (1) The intima-media thickness of the near wall cannot be measured in a valid way. (2) The lumen diameter of a blood vessel is defined by the distance from the leading edge of the intima-lumen interface of the near wall (echo zone 3) to the leading edge of the lumen-intima interface of the fall wall (echo zone 5). (3) Previously published studies have validated the intima-media complex of the far wall as the distance from the leading edge of the lumen-intima interface of the far wall to the leading edge of the media-adventitia interface of the far wall (echo zone 7). We suggest that if measurements on the near wall are performed, measurements from the far wall should also be presented separately, and if lumen diameter is measured, that this measurement is carried out according to the leading edge principle. We describe a computerized analysing system for the measurement of wall thickness and plaque area on the carotid and femoral arteries. The system is based on a low-cost PC and a frame grabber board and calculates minimum, maximum and mean values of lumen diameter and wall thickness from a section of the artery.
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                Author and article information

                Journal
                Circulation
                Circulation
                Ovid Technologies (Wolters Kluwer Health)
                0009-7322
                1524-4539
                September 02 1997
                September 02 1997
                : 96
                : 5
                : 1432-1437
                Affiliations
                [1 ]From the Department of Epidemiology and Biostatistics (M.L.B., A.W.H., A.H., D.E.G.) and Department of General Practice (A.W.H.), Erasmus University Medical School, Rotterdam, Netherlands; Julius Center of Patient Oriented Research (M.L.B., A.W.H., D.E.G.), Utrecht University, Netherlands; and Department of Neurology (P.J.K.), University Hospital Rotterdam, The Netherlands.
                Article
                10.1161/01.CIR.96.5.1432
                9315528
                © 1997

                Molecular medicine, Neurosciences

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