Elsevier

Atherosclerosis

Volume 211, Issue 2, August 2010, Pages 499-505
Atherosclerosis

Normative values and correlates of carotid artery intima-media thickness and carotid atherosclerosis in Andean-Hispanics: The Prevencion Study

https://doi.org/10.1016/j.atherosclerosis.2010.04.009Get rights and content

Abstract

Objectives

Carotid intima-media thickness (cIMT) is an independent predictor of cardiovascular risk. Furthermore, ethnicity and gender-specific normative data are required to assess cIMT, which are not available for Andean-Hispanics. In addition, data regarding correlates of subclinical atherosclerosis in ethnic population are needed.

Methods

We studied 1448 adults enrolled in a population-based study in Peru. cIMT and carotid plaque were measured with high-resolution ultrasonography. A healthy reference sample (n = 472) with no cardiovascular disease, normal weight and normal metabolic parameters was selected to establish normative cIMT values. Correlates of abnormal cIMT and carotid plaque were assessed in the entire population.

Results

In the reference sample, 95th-percentile cIMT values were both age and gender-dependent. In stepwise regression, selected predictors of increasing cIMT were: older age, impaired fasting glucose, diabetes mellitus, higher systolic blood pressure, higher LDL-cholesterol, smoking and male gender. Predictors of carotid plaque included older age, male gender, higher systolic blood pressure, lower diastolic blood pressure and higher LDL-cholesterol. HDL-cholesterol and C-reactive protein were not associated with cIMT or carotid plaque. The lack of association with HDL-cholesterol was confirmed using high performance liquid chromatography.

Conclusions

We present ethnic-specific cut-offs for abnormal cIMT applicable to Andean-Hispanics and correlates of subclinical atherosclerosis in this population. Pending longitudinal studies, our data supports several risk associations seen in other populations and can be used to identify Andean-Hispanics at increased risk for atherosclerotic cardiovascular disease. The lack of association between HDL-C and cIMT or carotid plaque in this population requires further investigation.

Introduction

Cardiovascular disease (CVD) has emerged as a leading cause of death in Latin America [1]. The early identification of subjects at risk for cardiovascular disease is important because prevention strategies instituted early are likely to have the highest impact in cardiovascular outcomes at the population level and these should be tailored to individual risk. Various cardiovascular risk stratification schemes have been developed using prospective data derived predominantly from Caucasian populations. These are largely based on individual risk factors that independently predict the risk of atherosclerotic cardiovascular disease. Given the ethnic diversity in the profile of CVD, varied risk associations and different levels of genetic–environmental interactions in different populations, such studies performed in Caucasian populations cannot be directly applied to Latin-American populations. Until prospective studies are available, the assessment of markers of subclinical atherosclerosis represents a useful approach to assess the correlates of atherosclerotic risk in Latin-American populations and individuals.

High-resolution carotid ultrasonography can determine the presence or extent of atherosclerosis in situ. Carotid artery intima-media thickness (cIMT) independently predicts the risk of cardiac (myocardial infarction, angina pectoris, coronary intervention) and cerebrovascular events (stroke or transient ischemic attack) [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], the involvement of other arterial beds with atherosclerosis [14], [15], [16] and is well suited for use in large-scale population studies as a marker of subclinical disease due to the relative simplicity and non-invasive nature of the technique. Appropriate interpretation of individual cIMT should be based on gender, age- and population-specific normative data [17]. However, such data are not available for Hispanic populations.

Andean populations represent an important proportion of South American Hispanics. Andean countries have important similarities, including related native Amerindian populations and historical patterns of colonization, which have influenced the patterns of genetic admixture and the cultural characteristics of their inhabitants. Although previous important studies have described cIMT and associated cardiovascular risk factors in Latin-American populations [18], [19], [20], studies assessing correlates of cIMT and the presence of carotid plaque in Andean adults are needed. In this study, we aimed to: (1) establish normative data for cIMT suitable for use among Andean-Hispanics; (2) assess the correlates of subclinical atherosclerosis assessed by cIMT and the presence of carotid plaque in this population.

Section snippets

Study population and sampling design

The objectives and design of the PREVENCION study have been previously published [21]. PREVENCION is a population-based study undertaken in the second largest city in Peru, with a population that is comparable to other urban populations in Peru and resembles urban populations in Andean countries such as Bolivia and Ecuador. This population consists largely of Mestizos (“Mixed”), with the degree of admixture being predominantly Andean-Amerindian (autochthonous Quechua and Aymara), with small

Results

The study population comprised 1448 participants [687 (47.4%) men] aged 20–87 years (mean age 52.4 years), of whom 472 (214 [45.3%] men) were found to be healthy. Important demographic, clinical and laboratory characteristics of the study population are shown in Table 1.

Discussion

We report on the cross-sectional associations between carotid atherosclerosis and classic cardiovascular risk factors in a large population-based sample of Andean-Hispanics. We also provide, for the first time, normative data for this population, which can be used to define abnormally high cIMT values in Andean-Hispanic adults aged 20–80 years. We show that cIMT in this population is associated with age, gender, SBP, LDL-C, current smoking, impaired fasting glucose and diabetes mellitus, but

Conflict of interest statement

Junichiro Takahashi and Gen Toshima are employees of Skylight Biotech (Tokyo, Japan) which provide commercially available services for HPLC measurements of serum lipoproteins. The other authors have no conflicts of interest.

Sources of funding

The PREVENCION study was supported by the Santa Maria Research Institute, AQP, Peru. JAC is supported by National Institutes of Health grant RO1-HL080076 and American Heart Association National Research Award #0885031N. CAP is supported by the National Institutes of Health Office of the Director, Fogarty International Center, Office of AIDS Research, National Cancer Center, National Eye Institute, National Heart, Blood, and Lung Institute, National Institute of Dental & Craniofacial Research,

References (29)

  • J.T. Salonen et al.

    Ultrasonographically assessed carotid morphology and the risk of coronary heart disease

    Arterioscler Thromb Vasc Biol

    (1991)
  • M.L. Bots et al.

    Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam study

    Circulation

    (1997)
  • D.H. O’Leary et al.

    Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults

    N Engl J Med

    (1999)
  • L.E. Chambless 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)
  • Cited by (26)

    • Relationship of endothelial nitric oxide synthase gene polymorphism with atherosclerotic coronary and carotid arterial disease in Egyptian population

      2015, Egyptian Heart Journal
      Citation Excerpt :

      Our results came in agreement with1 who showed that male gender (P = 0.006), older age (P < 0.001), smoking habit (0.002), hypertension (P = 0.002), diabetes mellitus (P = 0.062), high triglycerides level (P = 0.019) and impaired fasting blood glucose level (P = 0.036) are related to greater cIMT values. Similarly4 showed that cIMT is associated with increasing age, male gender, high SBP, high LDL-C, current smoking, impaired fasting glucose and diabetes mellitus. Our study showed that cIMT significantly increased in patients with coronary artery disease compared to those with normal coronaries (cIMT 1.060 ± 0.1386 vs. 0.809 ± 0.1634 mm, P value = <0.0001).

    • Serum levels of osteocalcin in relation to glucose metabolism and carotid atherosclerosis in Chinese middle-aged and elderly male adults: The Shanghai Changfeng Study

      2014, European Journal of Internal Medicine
      Citation Excerpt :

      The strengths of the study were that it was conducted on a large population-based cohort. Additionally, we used both CIMT and carotid plaques as the surrogate markers of atherosclerosis and the latter has been shown to be more strongly associated with cardiovascular risk than CIMT [34]. In summary, we confirmed that serum OCN level was inversely associated with glucose metabolism in male adults.

    • Gender as a moderator in the relationship between anxiety and carotid intima-media thickness: The PREVENCION study

      2013, Artery Research
      Citation Excerpt :

      Multiple linear regression analyses were used to test the association between anxiety and cIMT. Important control variables (identified previously as predictors of cIMT in this population)21 such as age, systolic blood pressure (SBP), diastolic blood pressure (DBP), impaired fasting glucose (fasting glucose 100–125 mg/dL), current smoking and low-density lipoprotein (LDL) cholesterol levels were included in the models. All tests were two-sided and α < 0.05 was considered to be statistically significant.

    View all citing articles on Scopus
    1

    On behalf of the PREVENCION Investigators.

    View full text