Abstract
Carotid ultrasound evaluation of intima-media thickness (IMT) and plaque burden has been used for risk stratification and for evaluation of antiatherosclerotic therapies. Increasing evidence indicates that measuring plaque burden is superior to measuring IMT for both purposes. We compared progression/regression of IMT, total plaque area (TPA), and total plaque volume (TPV) as predictors of cardiovascular outcomes. IMT, TPA, and TPV were measured at baseline in 349 patients attending vascular prevention clinics; they had TPA of 40 to 600 mm(2) at baseline to qualify for enrollment. Participants were followed up for ≤5 years (median, 3.17 years) to ascertain vascular death, myocardial infarction, stroke, and transient ischemic attacks. Follow-up measurements 1 year later were available in 323 cases for IMT and TPA, and in 306 for TPV. Progression of TPV predicted stroke, death or TIA (Kaplan-Meier logrank P=0.001), stroke/death/MI (P=0.008) and Stroke/Death/TIA/Myocardial infarction (any Cardiovascular event) (P=0.001). Progression of TPA weakly predicted Stroke/Death/TIA (P=0.097) but not stroke/death/MI (P=0.59) or any CV event (P=0.143); likewise change in IMT did not predict Stroke/Death/MI (P=0.13) or any CV event (P=0.455 ). In Cox regression, TPV progression remained a significant predictor of events after adjustment for coronary risk factors (P=0.001) but change in TPA did not. IMT change predicted events in an inverse manner; regression of IMT predicted events (P=0.004). For assessment of response to antiatherosclerotic therapy, measurement of TPV is superior to both IMT and TPA.
Highlights
Background and PurposeCarotid ultrasound evaluation of intima-media thickness (IMT) and plaque burden has been used for risk stratification and for evaluation of antiatherosclerotic therapies
In Cox regression, total plaque volume (TPV) progression remained a significant predictor of events after adjustment for coronary risk factors (P=0.001) but change in total plaque area (TPA) did not
For assessment of response to antiatherosclerotic therapy, measurement of TPV is superior to both IMT and TPA. (Stroke. 2013;44:1859-1865.)
Summary
IMT, TPA, and TPV were measured at baseline in 349 patients attending vascular prevention clinics; they had TPA of 40 to 600 mm[2] at baseline to qualify for enrollment. Follow-up measurements 1 year later were available in 323 cases for IMT and TPA, and in 306 for TPV. A Kolmogorov–Smirnov test of normality showed that continuous variables were not normally distributed, median and interquartile range were reported for descriptive statistics, and a Kruskal–Wallis test was used to test for differences among groups. Progression or regression of TPA, TPV, or IMT was defined by tertiles of change from baseline to 1 year later. Kaplan–Meier survival analysis was performed to assess event rate by progression, stability, or regression of the ultrasound variables; comparisons among groups were by the log-rank test pooled over strata. Cox regression, using a backward stepwise Wald approach, was used to evaluate effects of covariates: age, sex, smoking status, serum total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, and diabetes mellitus
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