The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease

the multi-ethnic study of atherosclerosis.

Joseph F. Polak, Moyses Szklo, Richard A. Kronmal, Gregory L. Burke, Steven Shea, Anna E H Zavodni, Daniel H. O'Leary

Research output: Contribution to journalArticle

Abstract

Carotid artery plaques are associated with coronary artery atherosclerotic lesions. We evaluated various ultrasound definitions of carotid artery plaque as predictors of future cardiovascular disease (CVD) and coronary heart disease (CHD) events. We studied the risk factors and ultrasound measurements of the carotid arteries at baseline of 6562 members (mean age 61.1 years; 52.6% women) of the Multi-Ethnic Study of Atherosclerosis (MESA). ICA lesions were defined subjectively as >0% or ≥25% diameter narrowing, as continuous intima-media thickness (IMT) measurements (maximum IMT or the mean of the maximum IMT of 6 images) and using a 1.5-mm IMT cut point. Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CHD, and stroke. Harrell's C-statistics, Net Reclassification Improvement, and Integrated Discrimination Improvement were used to evaluate the incremental predictive value of plaque metrics. At 7.8-year mean follow-up, all plaque metrics significantly predicted CVD events (n=515) when added to Framingham risk factors. All except 1 metric improved the prediction of CHD (by C-statistic, Net Reclassification Improvement, and Integrated Discrimination Improvement. Mean of the maximum IMT had the highest NRI (7.0%; P=0.0003) with risk ratio of 1.43/mm; 95% CI 1.26-1.63) followed by maximum IMT with an NRI of 6.8% and risk ratio of 1.27 (95% CI 1.18-1.38). Ultrasound-derived plaque metrics independently predict cardiovascular events in our cohort and improve risk prediction for CHD events when added to Framingham risk factors.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume2
Issue number2
DOIs
StatePublished - Apr 2013
Externally publishedYes

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Carotid Stenosis
Coronary Disease
Atherosclerosis
Cardiovascular Diseases
Odds Ratio
Carotid Arteries
Proportional Hazards Models
Coronary Vessels
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease : the multi-ethnic study of atherosclerosis. / Polak, Joseph F.; Szklo, Moyses; Kronmal, Richard A.; Burke, Gregory L.; Shea, Steven; Zavodni, Anna E H; O'Leary, Daniel H.

In: Journal of the American Heart Association, Vol. 2, No. 2, 04.2013.

Research output: Contribution to journalArticle

Polak, Joseph F. ; Szklo, Moyses ; Kronmal, Richard A. ; Burke, Gregory L. ; Shea, Steven ; Zavodni, Anna E H ; O'Leary, Daniel H. / The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease : the multi-ethnic study of atherosclerosis. In: Journal of the American Heart Association. 2013 ; Vol. 2, No. 2.
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abstract = "Carotid artery plaques are associated with coronary artery atherosclerotic lesions. We evaluated various ultrasound definitions of carotid artery plaque as predictors of future cardiovascular disease (CVD) and coronary heart disease (CHD) events. We studied the risk factors and ultrasound measurements of the carotid arteries at baseline of 6562 members (mean age 61.1 years; 52.6{\%} women) of the Multi-Ethnic Study of Atherosclerosis (MESA). ICA lesions were defined subjectively as >0{\%} or ≥25{\%} diameter narrowing, as continuous intima-media thickness (IMT) measurements (maximum IMT or the mean of the maximum IMT of 6 images) and using a 1.5-mm IMT cut point. Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CHD, and stroke. Harrell's C-statistics, Net Reclassification Improvement, and Integrated Discrimination Improvement were used to evaluate the incremental predictive value of plaque metrics. At 7.8-year mean follow-up, all plaque metrics significantly predicted CVD events (n=515) when added to Framingham risk factors. All except 1 metric improved the prediction of CHD (by C-statistic, Net Reclassification Improvement, and Integrated Discrimination Improvement. Mean of the maximum IMT had the highest NRI (7.0{\%}; P=0.0003) with risk ratio of 1.43/mm; 95{\%} CI 1.26-1.63) followed by maximum IMT with an NRI of 6.8{\%} and risk ratio of 1.27 (95{\%} CI 1.18-1.38). Ultrasound-derived plaque metrics independently predict cardiovascular events in our cohort and improve risk prediction for CHD events when added to Framingham risk factors.",
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