Open AccessThe Value of Carotid Artery Plaque and Intima‐Media Thickness for Incident Cardiovascular Disease: The Multi‐Ethnic Study of Atherosclerosis
Author(s) -
Polak Joseph F.,
Szklo Moyses,
Kronmal Richard A.,
Burke Gregory L.,
Shea Steven,
Zavodni Anna E. H.,
O'Leary Daniel H.
Publication year - 2013
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.113.000087
Subject(s) - medicine , cardiology , intima media thickness , hazard ratio , coronary artery disease , ultrasound , carotid arteries , stroke (engine) , confidence interval , radiology , mechanical engineering , engineering
Background Carotid artery plaques are associated with coronary artery atherosclerotic lesions. We evaluated various ultrasound definitions of carotid artery plaque as predictors of future cardiovascular disease ( CVD ) and coronary heart disease ( CHD ) events. Methods and Results We studied the risk factors and ultrasound measurements of the carotid arteries at baseline of 6562 members (mean age 61.1 years; 52.6% women) of the Multi‐Ethnic Study of Atherosclerosis ( MESA ). ICA lesions were defined subjectively as >0% or ≥25% diameter narrowing, as continuous intima‐media thickness ( IMT ) measurements (maximum IMT or the mean of the maximum IMT of 6 images) and using a 1.5‐mm IMT cut point. Multivariable C ox proportional hazards models were used to estimate hazard ratios for incident CVD , CHD , and stroke. H arrell's C ‐statistics, Net Reclassification Improvement, and Integrated Discrimination Improvement were used to evaluate the incremental predictive value of plaque metrics. At 7.8‐year mean follow‐up, all plaque metrics significantly predicted CVD events (n=515) when added to F ramingham risk factors. All except 1 metric improved the prediction of CHD (by C ‐statistic, Net Reclassification Improvement , and Integrated Discrimination Improvement. Mean of the maximum IMT had the highest NRI (7.0%; P =0.0003) with risk ratio of 1.43/mm; 95% CI 1.26–1.63) followed by maximum IMT with an NRI of 6.8% and risk ratio of 1.27 (95% CI 1.18–1.38). Conclusion Ultrasound‐derived plaque metrics independently predict cardiovascular events in our cohort and improve risk prediction for CHD events when added to F ramingham risk factors.