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ABSTRACT

Background The combined thickness of the intima and media of the carotid artery is associated with the prevalence of cardiovascular disease. We studied the associations between the thickness of the carotid-artery intima and media and the incidence of new myocardial infarction or stroke in persons without clinical cardiovascular disease.

Methods Noninvasive measurements of the intima and media of the common and internal carotid artery were made with high-resolution ultrasonography in 5858 subjects 65 years of age or older. Cardiovascular events (new myocardial infarction or stroke) served as outcome variables in subjects without clinical cardiovascular disease (4476 subjects) over a median follow-up period of 6.2 years.

Results The incidence of cardiovascular events correlated with measurements of carotid-artery intima–media thickness. The relative risk of myocardial infarction or stroke increased with intima–media thickness (P<0.001). The relative risk of myocardial infarction or stroke (adjusted for age and sex) for the quintile with the highest thickness as compared with the lowest quintile was 3.87 (95 percent confidence interval, 2.72 to 5.51). The association between cardiovascular events and intima–media thickness remained significant after adjustment for traditional risk factors, showing increasing risks for each quintile of combined intima–media thickness, from the second quintile (relative risk, 1.54; 95 percent confidence interval, 1.04 to 2.28), to the third (relative risk, 1.84; 95 percent confidence interval, 1.26 to 2.67), fourth (relative risk, 2.01; 95 percent confidence interval, 1.38 to 2.91), and fifth (relative risk, 3.15; 95 percent confidence interval, 2.19 to 4.52). The results of separate analyses of myocardial infarction and stroke paralleled those for the combined end point.

Conclusions Increases in the thickness of the intima and media of the carotid artery, as measured noninvasively by ultrasonography, are directly associated with an increased risk of myocardial infarction and stroke in older adults without a history of cardiovascular disease.

Source Information

From the Department of Radiology, Tufts–New England Medical Center, Boston (D.H.O.); the Department of Radiology, Brigham and Women's Hospital, Boston (J.F.P.); the Department of Biostatistics, University of Washington, Seattle (R.A.K.); the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md. (T.A.M.); the Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, N.C. (G.L.B.); and the Department of Surgery, University of Pittsburgh, Pittsburgh (S.K.W.).

Address reprint requests to the CHS Coordinating Center, Century Sq., 1501 4th Ave., Suite 2025, Seattle, WA 98101, or to daniel.oleary{at}es.nemc.org.

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Carotid-Artery Intima and Media Thickness as a Risk Factor for Myocardial Infarction and Stroke
Nichols W. W., Pepine C. J., O'Rourke M. F., O'Leary D. H., Polak J. F., Kronmal R. A.
Extract | Full Text  
N Engl J Med 1999; 340:1762-1763, Jun 3, 1999. Correspondence

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