Abstract
Current cardiovascular (CV) risk assessment tools using clinical risk factors alone are inadequate for predicting CV disease in low- to intermediate-risk patients. The presence of elevated carotid intimamedia thickness (CIMT) is a well-established risk factor for the development of CV disease. Recent studies have shown that the presence of carotid plaques is also a strong predictor of disease, independent of CIMT. Furthermore, complex carotid plaques are associated with both the acute coronary syndrome and cerebrovascular events. The use of subclinical atherosclerosis, defined as elevated CIMT or the presence of carotid plaques, in addition to clinical risk factor assessment is a sensitive method to assess future CV risk.
References and Recommended Reading
Downs JR, Clearfield M, Weis S, et al.: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998, 279:1615–1622.
Stamler J, Stamler R, Neaton JD, et al.: Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA 1999, 282:2012–2018.
Akosah KO, Schaper A, Cogbill C, Schoenfeld P: Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol 2003, 41:1475–1479.
Empana JP, Ducimetière P, Arveiler D, et al.: Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations? The PRIME study. Eur Heart J 2003, 24:1903–1911.
Brindle PM, McConnachie A, Upton MN, et al.: The accuracy of the Framingham risk-score in different socioeconomic groups: a prospective study. Br J Gen Pract 2005, 55:838–845.
Marques-Vidal P, Rodondi N, Bochud M, et al.: Predictive accuracy of original and recalibrated Framingham risk score in the Swiss population. Int J Cardiol 2008 May 14 (Epub ahead of print).
Centers for Disease Control and Prevention: Leading Causes of Death in Females: United States, 2004. Available at http://www.cdc.gov/Women/lcod.htm. Accessed January 30, 2009.
Touboul PJ, Hennerici MG, Meairs S, et al.: 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, 23:75–80.
Stein JH, Korcarz CE, Hurst RT, et al.: 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. American Society of Echocardiography Carotid Intima-Media Thickness Task Force. J Am Soc Echocardiogr 2008, 21:93–111; quiz 189–190.
Jashnani KD, Kulkarni RR, Deshpande JR: Role of carotid intima-media thickness in assessment of atherosclerosis: an autopsy study. Indian Heart J 2005, 57:319–323.
Farrar DJ, Riley WA, Bond MG, et al.: Detection of early atherosclerosis in M. fascicularis with transcutaneous ultrasonic measurement of the elastic properties of the common carotid artery. Tex Heart Inst J 1982, 9:335–343.
Bots ML, Baldassarre D, Simon A, et al.: Carotid intimamedia thickness and coronary atherosclerosis: weak or strong relations? Eur Heart J 2007, 28:398–406.
Hallerstam S, Larsson PT, Zuber E, Rosfors S: Carotid atherosclerosis is correlated with extent and severity of coronary artery disease evaluated by myocardial perfusion scintigraphy. Angiology 2004, 55:281–288.
Burke GL, Evans GW, Riley WA, et al.: Arterial wall thickness is associated with prevalent cardiovascular disease in middleaged adults. The Atherosclerosis Risk in Communities (ARIC) Study. Stroke 1995, 26:386–391.
Mattace Raso F, Rosato M, Talerico A, et al.: Intimalmedial thickness of the common carotid arteries and lower limbs atherosclerosis in the elderly. Minerva Cardioangiol 1999, 47:321–327.
Salonen JT, Salonen R: Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 1991, 11:1245–1249.
Bots ML, Hoes AW, Koudstaal PJ, et al.: Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997, 96:1432–1437.
Chambless LE, Heiss G, Folsom AR, et al.: 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, 146:483–494.
O’Leary DH, Polak JF, Kronmal RA, et al.: 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, 340:14–22.
Lorenz MW, Markus HS, Bots ML, et al.: Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007, 115:459–467.
Hodis HN, Mack WJ, LaBree L, et al.: The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med 1998, 128:262–269.
Psaty BM, Furberg CD, Kuller LH, et al.: Isolated systolic hypertension and subclinical cardiovascular disease in the elderly. Initial findings from the Cardiovascular Health Study. JAMA 1992, 268:1287–1291.
Wendelhag I, Wiklund O, Wikstrand J: Arterial wall thickness in familial hypercholesterolemia. Ultrasound measurement of intima-media thickness in the common carotid artery. Arterioscler Thromb 1992, 12:70–77.
Gnasso A, Pujia A, Irace C, Mattioli PL: Increased carotid arterial wall thickness in common hyperlipidemia. Coron Artery Dis 1995, 6:57–63.
Järvisalo MJ, Jartti L, Näntö-Salonen K, et al.: Increased aortic intima-media thickness: a marker of preclinical atherosclerosis in high-risk children. Circulation 2001, 104:2943–2947
Pujia A, Gnasso A, Irace C, et al.: Common carotid arterial wall thickness in NIDDM subjects. Diabetes Care 1994, 17:1330–1336.
Honzikova N, Labrova R, Fiser B, et al.: Influence of age, body mass index, and blood pressure on the carotid intimamedia thickness in normotensive and hypertensive patients. Biomed Tech (Berl) 2006, 51:159–162.
Howard G, Burke GL, Szklo M, et al.: Active and passive smoking are associated with increased carotid wall thickness. The Atherosclerosis Risk in Communities Study. Arch Intern Med 1994, 154:1277–1282.
Moskau S, Golla A, Grothe C, et al.: Heritability of carotid artery atherosclerotic lesions. An ultrasound study in 154 families. Stroke 2005, 36:5–8.
Zureik M, Temmar M, Adamopoulos C, et al.: Carotid plaques, but not common carotid intima-media thickness, are independently associated with aortic stiffness. J Hypertens 2002, 20:85–93.
Zureik M, Bureau JM, Temmar M, et al.: Echogenic carotid plaques are associated with aortic arterial stiffness in subjects with subclinical carotid atherosclerosis. Hypertension 2003, 41:519–527.
Roman MJ, Saba PS, Pini R, et al.: Parallel cardiac and vascular adaptation in hypertension. Circulation 1992, 86:1909–1918.
Bonithon-Kopp C, Touboul PJ, Berr C, et al.: Relation of intima-media thickness to atherosclerotic plaques in carotid arteries. The Vascular Aging (EVA) Study. Arterioscler Thromb Vasc Biol 1996, 16:310–316.
Prati P, Vanuzzo D, Casaroli M, et al.: Determinants of carotid plaque occurrence. A long-term prospective population study: the San Daniele Project. Cerebrovasc Dis 2006, 22:416–422.
Zureik M, Touboul PJ, Bonithon-Kopp C, et al.: Crosssectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population. The EVA Study. Stroke 1999, 30:550–555.
Kitamura A, Iso H, Imano H, et al.: Carotid intima-media thickness and plaque characteristics as a risk factor for stroke in Japanese elderly men. Stroke 2004, 35:2788–2794.
Rosvall M, Janzon L, Berglund G, et al.: Incident coronary events and case fatality in relation to common carotid intima-media thickness. J Intern Med 2005, 257:430–437.
Rosvall M, Janzon L, Berglund G, et al.: Incidence of stroke is related to carotid IMT even in the absence of plaque. Atherosclerosis 2005, 179:325–331.
Chien KL, Su TC, Jeng JS, et al.: Carotid artery intimamedia thickness, carotid plaque and coronary heart disease and stroke in Chinese. PLoS ONE 2008, 3:e3435.
Prati P, Tosetto A, Vanuzzo D, et al.: Carotid intima media thickness and plaques can predict the occurrence of ischemic cerebrovascular events. Stroke 2008, 39:2470–2476.
Baldassarre D, Amato M, Pustina L, et al.: Measurement of carotid artery intima-media thickness in dyslipidemic patients increases the power of traditional risk factors to predict cardiovascular events. Atherosclerosis 2007, 191:403–408.
Rundek T, Arif H, Boden-Albala B, et al.: Carotid plaque, a subclinical precursor of vascular events: the Northern Manhattan Study. Neurology 2008, 70:1200–1207.
Touboul PJ, Labreuche J, Vicaut E, et al.: Carotid intimamedia thickness, plaques, and Framingham risk score as independent determinants of stroke risk. Stroke 2005, 36:1741–1745.
Lau KK, Chan YH, Yiu KH, et al.: Incremental predictive value of vascular assessments combined with the Framingham risk score for prediction of coronary events in subjects of low-intermediate risk. Postgrad Med J 2008, 84:153–157.
Stork S, van den Beld AW, von Schacky C, et al.: Carotid artery plaque burden, stiffness, and mortality risk in elderly men: a prospective, population-based cohort study. Circulation 2004, 110:344–348.
Mathiesen EB, Bonaa KH, Joakimsen O: Low levels of high-density lipoprotein cholesterol are associated with echolucent carotid artery plaques: the Tromso study. Stroke 2001, 32:1960–1965.
Joakimsen O, Bønaa KH, Stensland-Bugge E: Reproducibility of ultrasound assessment of carotid plaque occurrence, thickness and morphology: the Tromso Study. Stroke 1997, 28:2201–2207.
Falk E, Shah PK, Fuster V: Coronary plaque disruption. Circulation 1995, 92:657–671.
Troyer A, Saloner D, Pan XM, et al.: Major carotid plaque surface irregularities correlate with neurologic symptoms. J Vasc Surg 2002, 35:741–747.
Rossi A, Franceschini L, Fusaro M, et al.: Carotid atherosclerotic plaque instability in patients with acute myocardial infarction. Int J Cardiol 2006, 111:263–266.
Triposkiadis F, Sitafidis G, Kostoulas J, et al.: Carotid plaque composition in stable and unstable coronary artery disease. Am Heart J 2005, 150:782–789.
Riley WA, Barnes RW, Applegate WB, et al.: Reproducibility of noninvasive ultrasonic measurement of carotid atherosclerosis. The Asymptomatic Carotid Artery Plaque Study. Stroke 1992, 23:1062–1068.
Beletsky VY, Kelley RE, Fowler M, Phifer T: Ultrasound densitometric analysis of carotid plaque composition. Pathoanatomic correlation. Stroke 1996, 27:2173–2177.
Reiter M, Horvat R, Puchner S, et al.: Plaque imaging of the internal carotid artery — correlation of B-flow imaging with histopathology. AJNR Am J Neuroradiol 2007, 28:122–126.
Watanabe Y, Nagayama M, Suga T, et al.: Characterization of atherosclerotic plaque of carotid arteries with histopathological correlation: vascular wall MR imaging vs. color Doppler ultrasonography (US). J Magn Reson Imaging 2008, 28:478–485.
Lal BK, Hobson RW 2nd, Pappas PJ, et al.: Pixel distribution analysis of B-mode ultrasound scan images predicts histologic features of atherosclerotic carotid plaques. J Vasc Surg 2002, 35:1210–1217.
Rakebrandt F, Crawford DC, Havard D, et al.: Relationship between ultrasound texture classification images and histology of atherosclerotic plaque. Ultrasound Med Biol 2000, 26:1393–1402.
Coli S, Magnoni M, Sangiorgi G, et al.: Contrast-enhanced ultrasound imaging of intraplaque neovascularization in carotid arteries: correlation with histology and plaque echogenicity. J Am Coll Cardiol 2008, 52:223–230.
Lovett JK, Gallagher PJ, Rothwell PM.: Reproducibility of histological assessment of carotid plaque: implications for studies of carotid imaging. Cerebrovasc Dis 2004, 18:117–123.
Jensen LO, Thayssen P, Pedersen KE, et al.: Regression of coronary atherosclerosis by simvastatin: a serial intravascular ultrasound study. Circulation 2004, 110:265–270.
Kang S, Wu Y, Li X: Effects of statin therapy on the progression of carotid atherosclerosis: a systematic review and meta-analysis. Atherosclerosis 2004, 177:433–442.
Naqvi TZ: Ultrasound carotid artery intima-media thickness assessment for progression of atherosclerosis in lipid intervention studies. Curr Opin Investig Drugs 2008, 9:256–264.
Cortellaro M, Cofrancesco E, Arbustini E, et al.: Atorvastatin and thrombogenicity of the carotid atherosclerotic plaque: the ATROCAP study. Thromb Haemost 2002, 88:41–47.
Yokoyama M, Komiyama N, Courtney BK, et al.: Plasma low-density lipoprotein reduction and structural effects on coronary atherosclerotic plaques by atorvastatin as clinically assessed with intravascular ultrasound radio-frequency signal analysis: a randomized prospective study. Am Heart J 2005, 150:287.
Yamagami H, Sakaguchi M, Furukado S, et al.: Statin therapy increases carotid plaque echogenicity in hypercholesterolemic patients. Ultrasound Med Biol 2008, 34:1353–1359.
Kumeda Y, Inaba M, Goto H, et al.: Increased thickness of the arterial intima-media detected by ultrasonography in patients with rheumatoid arthritis. Arthritis Rheum 2002, 46:1489–1497.
Sankatsing RR, Wit FW, Vogel M, et al.: Increased carotid intima-media thickness in HIV patients treated with protease inhibitors as compared to non-nucleoside reverse transcriptase inhibitors. Atherosclerosis 2009, 202:589–595.
Mack WJ, Slater CC, Xiang M, et al.: Elevated subclinical atherosclerosis associated with oophorectomy is related to time since menopause rather than type of menopause. Fertil Steril 2004, 82:391–397.
Korcarz CE, DeCara JM, Hirsch AT, et al.: Ultrasound detection of increased carotid intima-media thickness and carotid plaque in an office practice setting: does it affect physician behavior or patient motivation? J Am Soc Echocardiogr 2008, 21:1156–1162.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Daneshvar, S.A., Naqvi, T.Z. Carotid intima-media thickness and carotid plaques in cardiovascular risk assessment. Curr Cardio Risk Rep 3, 121–130 (2009). https://doi.org/10.1007/s12170-009-0020-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12170-009-0020-0