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The Role of Carotid Arterial Intima-Media Thickness in Predicting Clinical Coronary Events

Howard N. Hodis, MD; Wendy J. Mack, PhD; Laurie LaBree, MS; Robert H. Selzer, MS; Chao-ran Liu, MD; Ci-hua Liu, MD; and Stanley P. Azen, PhD
[+] Article and Author Information

From University of Southern California School of Medicine, Los Angeles, California; and California Institute of Technology, Pasadena, California. Grant Support: By the National Heart, Lung, and Blood Institute through investigator-initiated grants to Dr. Hodis (RO1-HL-49885) and Dr. Mack (RO3-HL-54532). Requests for Reprints: Howard N. Hodis, MD, Atherosclerosis Research Unit, Division of Cardiology, University of Southern California School of Medicine, 2250 Alcazar Street, CSC 132, Los Angeles, CA 90033. Current Author Addresses: Drs. Hodis, Chao-ran Liu, and Ci-hua Liu: Atherosclerosis Research Unit, Division of Cardiology, University of Southern California School of Medicine, 2250 Alcazar Street, CSC 132, Los Angeles, CA 90033.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(4):262-269. doi:10.7326/0003-4819-128-4-199802150-00002
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Background: Carotid arterial intima-media thickness is used as a noninvasive surrogate end point to measure progression of atherosclerosis, but its relation to coronary events has not been fully explored.

Objective: To determine whether carotid arterial intima-media thickness predicts coronary events.

Design: Long-term follow-up (average, 8.8 years) of a previously assembled cohort of persons who completed the 2-year Cholesterol Lowering Atherosclerosis Study, a randomized arterial imaging trial designed to study the effects of lipid lowering on progression of atherosclerosis.

Setting: University-based ultrasonography laboratory.

Patients: 146 men 40 to 59 years of age who had previously had coronary artery bypass graft surgery.

Measurements: Preintrusive atherosclerosis in the common carotid artery was evaluated every 6 months with B-mode ultrasonography, and intrusive atherosclerosis in the coronary arteries was evaluated at baseline and at 2 years with quantitative coronary angiography. After the trial, the incidences of coronary events (nonfatal acute myocardial infarction, coronary death, and coronary artery revascularization) were documented.

Results: For each 0.03-mm increase per year in carotid arterial intima-media thickness, the relative risk for non-fatal myocardial infarction or coronary death was 2.2 (95% CI, 1.4 to 3.6) and the relative risk for any coronary event was 3.1 (CI, 2.1 to 4.5) (P < 0.001). Absolute intima-media thickness was also related to risk for clinical coronary events (P < 0.02). Absolute thickness and progression in thickness predicted risk for coronary events beyond that predicted by coronary arterial measures of atherosclerosis and lipid measurements (P < 0.001).

Conclusion: Noninvasive B-mode ultrasonographic measurement of progression of intima-media thickness in the distal common carotid artery is a useful surrogate end point for clinical coronary events.

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