IMT for the Elderly?

Abstract

To the Editor: I would like to respond to an article published in a recent issue of Stroke , entitled “Is Carotid Intima-Media Thickness Useful in Cardiovascular Disease Risk Assessment?”1 The title of the article caught my eye because my profession involves extensive use of carotid intima-media thickness (CIMT) for detection of atherosclerosis. However, I was surprised that the title did not reflect the misleading nature of the article, and it appears to refute the authors’ earlier published works.2 The title of the article suggests that certain cardiovascular risks were compared with assessment of CIMT. The authors of this article concluded that as a screening tool, CIMT does not represent a substantial increase in the predictive value for cardiovascular events. Moreover, there was an inference that CIMT cannot be used alone as a screening tool. I must completely disagree. The article described the Rotterdam Study, in which investigators used CIMT as a screening tool in an elderly population. This was a select population that would have additional risk factors present. The question should have been raised as to whether exclusive use of CIMT in a younger population with risk factors is able to identify the presence of cardiovascular disease in its earliest …