Carotid Artery Plaques,Carotid Intima–Media Thickness,and Risk of Cardiovascular Events and All-Cause Death in Older Adults: A 5-Year Prospective,Community-Based Study
Restricted accessResearch articleFirst published online February, 2018
Carotid Artery Plaques,Carotid Intima–Media Thickness,and Risk of Cardiovascular Events and All-Cause Death in Older Adults: A 5-Year Prospective,Community-Based Study
We assessed the effect of asymptomatic carotid atherosclerosis (CAS) on the development of cardiovascular diseases (CVDs) in a community-based population aged ≥55 years in China. A total of 1376 residents underwent CAS assessment by ultrasonography in July 2009. New CVD events, including stroke and coronary heart events, were collected at the follow-up survey at the end of 2014. After adjusting for baseline demographic characteristics and traditional CVD risk factors, the risk of CVD in patients with minimal CAS (mean common carotid artery intima–media thickness [CCA-IMT] ≥1 mm and no plaques), nonstenotic plaques (carotid stenosis <50%), and stenotic plaques (carotid stenosis ≥50%) was 0.8 (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.33-1.69), 2.0 (HR: 2.01, 95% CI: 1.24-3.25), and 3.1 (HR: 3.05, 95% CI: 1.62-5.74) times greater, respectively, than that of patients without CAS (CCA-IMT <1 mm and no plaques). Our findings provide direct evidence of the independent predictive value of the severity of asymptomatic CAS for the development of CVD in older Chinese adults.
StegmayrBAsplundKKuulasmaaKRajakangasAMThorvaldsenPTuomilehtoJ. Stroke incidence and mortality correlated to stroke risk factors in the WHO MONICA Project. An ecological study of 18 populations. Stroke. 1997;28(7):1367–1374.
2.
WuZYaoCZhaoD. Sino-MONICA project: a collaborative study on trends and determinants in cardiovascular diseases in China, Part I: Morbidity and mortality monitoring. Circulation. 2001;103(3):462–468.
3.
WangWHuSSKongLZ. Summary of report on cardiovascular diseases in China, 2012. Biomed Environ Sci. 2014;27(7):552–558.
4.
National Center For Cardiovascular Diseases C. Report on cardiovascular diseases in China (2016). Beijing: Encyclopedia of China publishing house; 2017.
5.
WangWJiangBSunH. Prevalence, incidence and mortality of stroke in China: results from a nationwide population-based survey of 480,687 adults. Circulation. 2017;135(8):759–771.
6.
YiZVaupelJW. Functional capacity and self-evaluation of health and life of oldest old in china. 2002;58(4):733–748.
7.
LorenzMWPolakJFKavousiM. Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data. Lancet. 2012;379(9831):2053–2062.
8.
Den RuijterHMPetersSAAndersonTJ. Common carotid intima-media thickness measurements in cardiovascular risk prediction: a meta-analysis. JAMA. 2012;308(8):796–803.
9.
PolakJFPencinaMJO’LearyDHD’AgostinoRB. Common carotid artery intima-media thickness progression as a predictor of stroke in Multi-Ethnic Study of Atherosclerosis. Stroke. 2011;42(11):3017–3021.
10.
NambiVChamblessLFolsomAR. Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk in Communities) study. J Am Coll Cardiol. 2010;55(15):1600–1607.
11.
BergerJSJordanCOLloyd-JonesDBlumenthalRS. Screening for cardiovascular risk in asymptomatic patients. J Am Coll Cardiol. 2010;55(12):1169–1177.
12.
ChamblessLEHeissGFolsomAR. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993. Am J Epidemiol. 1997;146(6):483–494.
13.
O’LearyDHPolakJFKronmalRAManolioTABurkeGLWolfsonSJ. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340(1):14–22.
14.
PolakJFPencinaMJPencinaKMO’DonnellCJWolfPAD’AgostinoRS. Carotid-wall intima-media thickness and cardiovascular events. N Engl J Med. 2011;365(3):213–221.
15.
van der MeerIMBotsMLHofmanAdel SolAIvan der KuipDAWittemanJC. Predictive value of noninvasive measures of atherosclerosis for incident myocardial infarction: the Rotterdam study. Circulation. 2004;109(9):1089–1094.
16.
InabaYChenJABergmannSR. Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. Atherosclerosis. 2012;220(1):128–133.
17.
PolakJFSzkloMKronmalRA. The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2013;2(2):e000087.
18.
BrinjikjiWRabinsteinAALanzinoG. Ultrasound characteristics of symptomatic carotid plaques: a systematic review and meta-analysis. Cerebrovasc Dis. 2015;40(3-4):165–174.
19.
XieWLiangLZhaoL. Combination of carotid intima-media thickness and plaque for better predicting risk of ischaemic cardiovascular events. Heart. 2011;97(16):1326–1331.
20.
WangDWangJJinC. Asymptomatic extracranial artery stenosis and the risk of cardiovascular and cerebrovascular diseases. Sci Rep. 2016;6:33960.
21.
ChenPJengJHsuHSuTChienKLeeY. Carotid atherosclerosis progression and risk of cardiovascular events in a community in Taiwan. Sci Rep. 2016;6:25733.
22.
SchmidtCBergstromG. Carotid artery intima-media thickness predicts major cardiovascular events during 7-year follow-up in 64-year-old women irrespective of other glucometabolic factors. Angiology. 2017;68(6):553–558.
23.
GardinJMBartzTMPolakJFO’LearyDHWongND. What do carotid intima-media thickness and plaque add to the prediction of stroke and cardiovascular disease risk in older adults? The Cardiovascular Health Study. J Am Soc Echocardiogr. 2014;27(9):998–1005.e2.
24.
HaldEMLijferingWMMathiesenEB. Carotid atherosclerosis predicts future myocardial infarction but not venous thromboembolism: The Tromso study. Arterioscler Thromb Vasc Biol. 2014;34(1):226–230.
25.
BaldassarreDVegliaFHamstenA. Progression of carotid intima-media thickness as predictor of vascular events: results from the IMPROVE study. Arterioscler Thromb Vasc Biol. 2013;33(9):2273–2279.
26.
TangZWangHXMengC. The prevalence of functional disability in activities of daily living and instrumental activities of daily living among elderly Beijing Chinese. Arch Gerontol Geriatr. 1999;29(2):115–125.
27.
JiangJTangZFutatsukaM. The impact of ADL disability on depression symptoms in a community of Beijing elderly, China. Environ Health Prev Med. 2002;7(5):199–204.
28.
WangCSongXMitnitskiA. Gender differences in the relationship between smoking and frailty: results from the Beijing Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci. 2013;68(3):338–346.
29.
ZhangZFangXHuaY. Combined effect of hyperhomocysteinemia and hypertension on the presence of early carotid artery atherosclerosis. J Stroke Cerebrovasc Dis. 2016;25(5):1254–1262.
30.
GuXFangXHuaY. Association between kidney dysfunction and carotid atherosclerosis in community-based older adults in china. Angiology. 2016;67(3):252–258.
31.
TouboulPJHennericiMGMeairsS. Mannheim carotid intima-media thickness consensus (2004-2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis. 2007;23(1):75–80.
32.
WuYLiuFAdiD. Association between carotid atherosclerosis and different subtypes of hypertension in adult populations: a multiethnic study in Xinjiang, China. PLoS One. 2017;12(2):e0171791.
33.
KernRSzaboKHennericiMMeairsS. Characterization of carotid artery plaques using real-time compound B-mode ultrasound. Stroke. 2004;35(4):870–875.
34.
JoakimsenOBonaaKHStensland-BuggeE. Reproducibility of ultrasound assessment of carotid plaque occurrence, thickness, and morphology. The Tromso Study. Stroke. 1997;28(11):2201–2207.
35.
GrantEGBensonCBMonetaGL. Carotid artery stenosis: Gray-scale and Doppler US diagnosis—Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003;229(2):340–346.
36.
ChobanianAVBakrisGLBlackHR. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560–2572.
37.
Standards of medical care in diabetes--2011. Diabetes Care. 2011;34(suppl 1):S11–S61.
38.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Circulation. 2002;106(25):3143–3421.
39.
RundekTArifHBoden-AlbalaBElkindMSPaikMCSaccoRL. Carotid plaque, a subclinical precursor of vascular events: The Northern Manhattan Study. Neurology. 2008;70(14):1200–1207.
40.
GepnerADYoungRDelaneyJA. Comparison of coronary artery calcium presence, carotid plaque presence, and carotid intima-media thickness for cardiovascular disease prediction in the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging. 2015;8(1):e002262.
41.
SkagenKSkjellandMZamaniMRussellD. Unstable carotid artery plaque: new insights and controversies in diagnostics and treatment. Croat Med J. 2016;57(4):311–320.
42.
HuibersAde BorstGJBulbuliaRPanHHallidayA. Plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first asymptomatic carotid surgery trial (ACST-1). Eur J Vasc Endovasc. 2016;51(5):616–621.
43.
GuptaAKesavabhotlaKBaradaranH. Plaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis. Stroke. 2015;46(1):91–97.
44.
StorkSvan den BeldAWvon SchackyC. Carotid artery plaque burden, stiffness, and mortality risk in elderly men: a prospective, population-based cohort study. Circulation. 2004;110(3):344–348.
45.
JungJMKwonDYHanCJoIJoSAParkMH. Increased carotid intima-media thickness and plasma homocysteine levels predict cardiovascular and all-cause death: a population-based cohort study. Eur Neurol. 2013;70(1-2):1–5.
46.
AndoFTakekumaKNiinoNShimokataH. Ultrasonic evaluation of common carotid intima-media thickness (IMT)—influence of local plaque on the relationship between IMT and age. J Epidemiol. 2000;10(1 suppl):S10–S17.
47.
ChengKSMikhailidisDPHamiltonGSeifalianAM. A review of the carotid and femoral intima-media thickness as an indicator of the presence of peripheral vascular disease and cardiovascular risk factors. Cardiovasc Res. 2002;54(3):528–538.
48.
SteinJHKorcarzCEHurstRT. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21(2):93–111;quiz 189-190.
49.
JohnsenSHMathiesenEB. Carotid plaque compared with intima-media thickness as a predictor of coronary and cerebrovascular disease. Curr Cardiol Rep. 2009;11(1):21–27.
50.
NaqviTZLeeMS. Carotid intima-media thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging. 2014;7(10):1025–1038.
51.
PlichartMCelermajerDSZureikM. Carotid intima-media thickness in plaque-free site, carotid plaques and coronary heart disease risk prediction in older adults. The three-city study. Atherosclerosis. 2011;219(2):917–924.
JuoSHLinHFRundekT. Genetic and environmental contributions to carotid intima-media thickness and obesity phenotypes in the Northern Manhattan Family Study. Stroke. 2004;35(10):2243–2247.
54.
MoskauSGollaAGrotheCBoesMPohlCKlockgetherT. Heritability of carotid artery atherosclerotic lesions: an ultrasound study in 154 families. Stroke. 2005;36(1):5–8.
55.
FinnAVKolodgieFDVirmaniR. Correlation between carotid intimal/medial thickness and atherosclerosis: a point of view from pathology. Arterioscler Thromb Vasc Biol. 2010;30(2):177–181.
56.
SpenceJDHegeleRA. Noninvasive phenotypes of atherosclerosis: similar windows but different views. Stroke. 2004;35(3):649–653.
57.
RamanGMoorthyDHadarN. Management strategies for asymptomatic carotid stenosis: a systematic review and meta-analysis. Ann Intern Med. 2013;158(9):676–685.
58.
WeyerGWDavisAM. Screening for asymptomatic carotid artery stenosis. JAMA. 2015;313(2):192–193.
59.
JonasDEFeltnerCAmickHR. Screening for asymptomatic carotid artery stenosis: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;161(5):336–346.
60.
BotsMLHoesAWKoudstaalPJHofmanAGrobbeeDE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997;96(5):1432–1437.
61.
HodisHNMackWJLaBreeL. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med. 1998;128(4):262–269.
62.
BaldassarreDHamstenAVegliaF. Measurements of carotid intima-media thickness and of interadventitia common carotid diameter improve prediction of cardiovascular events: results of the IMPROVE (Carotid Intima Media Thickness [IMT] and IMT-Progression as Predictors of Vascular Events in a High Risk European Population) study. J Am Coll Cardiol. 2012;60(16):1489–1499.
63.
SonkaMLiangWLauerRM. Automated analysis of brachial ultrasound image sequences: early detection of cardiovascular disease via surrogates of endothelial function. IEEE Trans Med Imaging. 2002;21(10):1271–1279.
64.
BeuxFCarmassiSSalvettiMV. Automatic evaluation of arterial diameter variation from vascular echographic images. Ultrasound Med Biol. 2001;27(12):1621–1629.
