Carotid-wall intima–media thickness and cardiovascular events

January 01, 0001

Carotid-wall intima-media thickness and cardiovascular events

These US authors measured the mean intima-media thickness of the common carotid artery and the maximum intima-media thickness of the internal carotid artery in 2965 members of the Framingham Offspring Study cohort. Cardiovascular-disease outcomes were evaluated for an average follow-up of 7.2 years. They evaluated the reclassification of cardiovascular disease on the basis of the 8-year Framingham risk score category (low, intermediate, or high) after adding intima-media thickness values.

They found: "A total of 296 participants had a cardiovascular event. The risk factors of the Framingham risk score predicted these events, with a C statistic of 0.748. The adjusted hazard ratio for cardiovascular disease with a 1-SD increase in the mean intima-media thickness of the common carotid artery was 1.13, with a nonsignificant change in the C statistic of 0.003; the corresponding hazard ratio for the maximum intima-media thickness of the internal carotid artery was 1.21, with a modest increase in the C statistic of 0.009. The net reclassification index increased significantly after addition of intima-media thickness of the internal carotid artery (7.6%) but not intima-media thickness of the common carotid artery (0.0%). With the presence of plaque, defined as intima-media thickness of the internal carotid artery of more than 1.5 mm, the net reclassification index was 7.3%, with an increase in the C statistic of 0.014."

The authors concluded: "The maximum internal and mean common carotid-artery intima-media thicknesses both predict cardiovascular outcomes, but only the maximum intima-media thickness of (and presence of plaque in) the internal carotid artery significantly (albeit modestly) improves the classification of risk of cardiovascular disease in the Framingham Offspring Study cohort."

The next question is whether the added information allows intervention that improves outcomes.


For the full abstract, click here.

N Engl J Med 365:213-221, 21 July 2011 © 2011 to the Massachusetts Medical Society
Carotid-Wall Intima-Media Thickness and Cardiovascular Events. Joseph F. Polak, Michael J. Pencina, Karol M. Pencina, et al. Correspondence to: Dr. Polak: [email protected]

Category: K. Circulatory. Keywords: Framingham risk score, cardiovascular events, risk prediction, carotid artery, intima-media thickness, prospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 9 August 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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