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      Segment-specific association of carotid-intima-media thickness with cardiovascular risk factors – findings from the STAAB cohort study

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          Abstract

          Background

          The guideline recommendation to not measure carotid intima-media thickness (CIMT) for cardiovascular risk prediction is based on the assessment of just one single carotid segment. We evaluated whether there is a segment-specific association between different measurement locations of CIMT and cardiovascular risk factors.

          Methods

          Subjects from the population-based STAAB cohort study comprising subjects aged 30 to 79 years of the general population from Würzburg, Germany, were investigated. CIMT was measured on the far wall of both sides in three different predefined locations: common carotid artery (CCA), bulb, and internal carotid artery (ICA). Diabetes, dyslipidemia, hypertension, smoking, and obesity were considered as risk factors. In multivariable logistic regression analysis, odds ratios of risk factors per location were estimated for the endpoint of individual age- and sex-adjusted 75th percentile of CIMT.

          Results

          2492 subjects were included in the analysis. Segment-specific CIMT was highest in the bulb, followed by CCA, and lowest in the ICA. Dyslipidemia, hypertension, and smoking were associated with CIMT, but not diabetes and obesity. We observed no relevant segment-specific association between the three different locations and risk factors, except for a possible interaction between smoking and ICA.

          Conclusions

          As no segment-specific association between cardiovascular risk factors and CIMT became evident, one simple measurement of one location may suffice to assess the cardiovascular risk of an individual.

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          Most cited references24

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          Mannheim Carotid Intima-Media Thickness and Plaque Consensus (2004–2006–2011)

          Intima-media thickness (IMT) provides a surrogate end point of cardiovascular outcomes in clinical trials evaluating the efficacy of cardiovascular risk factor modification. Carotid artery plaque further adds to the cardiovascular risk assessment. It is defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding IMT value or demonstrates a thickness >1.5 mm as measured from the media-adventitia interface to the intima-lumen interface. The scientific basis for use of IMT in clinical trials and practice includes ultrasound physics, technical and disease-related principles as well as best practice on the performance, interpretation and documentation of study results. Comparison of IMT results obtained from epidemiological and interventional studies around the world relies on harmonization on approaches to carotid image acquisition and analysis. This updated consensus document delineates further criteria to distinguish early atherosclerotic plaque formation from thickening of IMT. Standardized methods will foster homogenous data collection and analysis, improve the power of randomized clinical trials incorporating IMT and plaque measurements and facilitate the merging of large databases for meta-analyses. IMT results are applied to individual patients as an integrated assessment of cardiovascular risk factors. However, this document recommends against serial monitoring in individual patients.
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            2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

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              Measurement of arterial wall thickness as a surrogate marker for atherosclerosis.

              Large observational studies and atherosclerosis regression trials of lipid-modifying pharmacotherapy have established that intima-media thickness of the carotid and femoral arteries, as measured noninvasively by B-mode ultrasound, is a valid surrogate marker for the progression of atherosclerotic disease. To exploit fully the potential of ultrasound imaging in atherosclerosis research, standardized and strictly implemented imaging protocols should be used in both observational studies and applied clinical research. This article describes such a protocol developed at the Academic Medical Center of the University of Amsterdam, the Netherlands. Results are presented from a study that estimated atherosclerosis progression from childhood into old age by measuring intima-media thickness in subjects with familial hypercholesterolemia compared with healthy controls.
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                Author and article information

                Contributors
                lara.mueller-scholden@gmx.de
                kirchhofjan@gmx.de
                Morbach_C@ukw.de
                Breunig_M@ukw.de
                r.meijer@meijermedicalultrasound.com
                E_Ruecker_V@ukw.de
                Tiffe_T@ukw.de
                Yurdadogan_T@ukw.de
                Wagner_M@ukw.de
                E_Gelbrich_G@ukw.de
                m.bots@umcutrecht.nl
                Stoerk_S@ukw.de
                E_Heuschma_P@ukw.de
                Journal
                BMC Cardiovasc Disord
                BMC Cardiovasc Disord
                BMC Cardiovascular Disorders
                BioMed Central (London )
                1471-2261
                4 April 2019
                4 April 2019
                2019
                : 19
                : 84
                Affiliations
                [1 ]ISNI 0000 0001 1378 7891, GRID grid.411760.5, Comprehensive Heart Failure Center Würzburg, , University and University Hospital Würzburg, ; Straubmühlweg 15, 97080 Würzburg, Germany
                [2 ]ISNI 0000 0001 1378 7891, GRID grid.411760.5, Department of Internal Medicine I, , University Hospital Würzburg, ; Würzburg, Germany
                [3 ]ISNI 0000000090126352, GRID grid.7692.a, Julius Center for Health Sciences and Primary Care, , University Medical Center Utrecht, ; Utrecht, The Netherlands
                [4 ]ISNI 0000 0001 1958 8658, GRID grid.8379.5, Institute of Clinical Epidemiology and Biometry, , University of Würzburg, ; Würzburg, Germany
                [5 ]ISNI 0000 0001 1378 7891, GRID grid.411760.5, Clinical Trial Center, , University Hospital Würzburg, ; Würzburg, Germany
                Author information
                http://orcid.org/0000-0001-6483-1805
                Article
                1044
                10.1186/s12872-019-1044-0
                6449987
                30947692
                56250f3c-33c0-4caf-9b4d-0cc46267ccb6
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 November 2018
                : 14 March 2019
                Funding
                Funded by: BMBF
                Award ID: 01EO1004 and 01EO1504
                Funded by: GSLS
                Funded by: FundRef http://dx.doi.org/10.13039/501100001659, Deutsche Forschungsgemeinschaft;
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Cardiovascular Medicine
                carotid intima-media thickness (cimt),cardiovascular risk prediction,carotid segment,carotid ultrasound,cardiovascular risk factors

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