Changes In Maximum Intima-media Thickness Research Articles

Short-term progression of maximum intima-media thickness of carotid plaque is associated with future coronary events in patients with coronary artery disease

ObjectiveThis study examined whether changes in maximum intima-media thickness of carotid plaque (plaque-IMTmax) over 6 months predict future coronary events in patients with carotid plaque and coronary artery disease (CAD). MethodsThis study included 240 patients with CAD who had a carotid plaque (IMT≥1.1mm) at entry. A carotid ultrasound examination was performed at entry (1st test) and after 6 months (2nd test). The carotid plaque with the greatest axial thickness at the 1st test was selected as the target plaque for monitoring the change in plaque-IMTmax. After the 2nd test, patients were prospectively followed-up for 3 years or until the occurrence of one of the following coronary events: cardiac death, non-fatal myocardial infarction, or unstable angina pectoris requiring coronary revascularization. ResultsThe change in plaque-IMTmax over 6 months ranged from −0.85 to 0.97mm (mean, −0.006±0.319mm). There were 41 events during follow-up. In a stepwise multivariate Cox proportional hazards model, the change in plaque-IMTmax was a significant predictor of coronary events after adjustment for known risk factors (HR per 0.1mm increase over 6 months, 1.21; 95%CI, 1.10–1.33, p=0.0001). Analysis of receiver operating characteristic (ROC) curves showed that the addition of the change in plaque-IMTmax to conventional risk factors resulted in a greater area under the ROC curve compared with conventional risk factors alone (0.81 and 0.70, respectively, p=0.02). ConclusionShort-term progression of carotid plaque-IMTmax was associated with future coronary events in patients with CAD.

Occupational physical activity, energy expenditure and 11-year progression of carotid atherosclerosis

This study prospectively assessed the effects of occupational physical activity on atherosclerosis progression. This population-based prospective study of ultrasonographically assessed carotid intima media thickness (IMT) used repeated measures of occupational physical activity during baseline, 4-year, and 11-year examinations of 612 Finnish men 42-60 years of age at baseline. The association between five measures of energy expenditure and the 11-year change in maximum IMT was evaluated in regression models adjusting for 21 potential confounders, including biological factors, leisure-time physical activity, smoking, socioeconomic status, psychosocial job factors, and baseline health status. At baseline, 31% of all the men and 51% of those with ischemic heart disease (IHD) exceeded the recommended maximum levels of relative aerobic strain. All five measures of energy expenditure were significantly associated with adjusted 11-year IMT change. Significant interactions were found between IHD and several measures of energy expenditure. Maximum relative aerobic strain resulted in a 90% increase in IMT among the men with IHD compared with a 46% increase among those without IHD. The men with preexisting carotid stenosis also had higher rates of IMT progression than the men without this condition. This study shows that high energy expenditures at work are associated with an accelerated progression of atherosclerosis even after control for virtually all known cardiovascular risk factors, especially among older workers and workers with preexisting IHD or carotid artery stenosis. The findings support the hemodynamic theory of atherosclerosis and have important implications for workplace surveillance and disease prevention.

Torcetrapib and carotid intima-media thickness in mixed dyslipidaemia (RADIANCE 2 study): a randomised, double-blind trial

Patients with mixed dyslipidaemia have raised triglycerides, low high-density lipoprotein (HDL) cholesterol, and high low-density lipoprotein (LDL) cholesterol. Augmentation of HDL cholesterol by inhibition of the cholesteryl ester transfer protein (CETP) could benefit these patients. We aimed to investigate the effect of the CETP inhibitor, torcetrapib, on carotid atherosclerosis progression in patients with mixed dyslipidaemia. We did a randomised double-blind trial at 64 centres in North America and Europe. 752 eligible participants completed an atorvastatin-only run-in period for dose titration, after which they all continued to receive atorvastatin at the titrated dose. 377 of these patients were randomly assigned to receive 60 mg of torcetrapib per day and 375 to placebo. We made carotid ultrasound images at baseline and at 6-month intervals for 24 months. The primary endpoint was the yearly rate of change in the maximum intima-media thickness of 12 carotid segments. Analysis was restricted to 683 patients who had at least one dose of treatment and had at least one follow-up carotid intima-media measurement; they were analysed as randomised. Mean follow-up for these patients was 22 (SD 4.8) months. This trial is registered with ClinicalTrials.gov, number NCT00134238. The change in maximum carotid intima-media thickness was 0.025 (SD 0.005) mm per year in patients given torcetrapib with atorvastatin and 0.030 (0.005) mm per year in those given atorvastatin alone (difference -0.005 mm per year, 95% CI -0.018 to 0.008, p=0.46). Patients in the combined-treatment group had a 63.4% relative increase in HDL cholesterol (p<0.0001) and an 17.7% relative decrease in LDL cholesterol (p<0.0001), compared with controls. Systolic blood pressure increased by 6.6 mm Hg in the combined-treatment group and 1.5 mm Hg in the atorvastatin-only group (difference 5.4 mm Hg, 95% CI 4.3-6.4, p<0.0001). Although torcetrapib substantially raised HDL cholesterol and lowered LDL cholesterol, it also increased systolic blood pressure, and did not affect the yearly rate of change in the maximum intima-media thickness of 12 carotid segments. Torcetrapib showed no clinical benefit in this or other studies, and will not be developed further.

Standing at work and progression of carotid atherosclerosis.

The association between the amount of standing at work and the progression of carotid intima media thickness (IMT) was studied among 584 active working men participating in the Kuopio Ischemic Heart Disease Risk Factor Study. Ultrasound measurements of atherosclerotic changes in the carotid arteries were performed at the beginning of the study and after 4 years. Analyses of changes in IMT included adjustments for risk factors and stratification by base-line levels of atherosclerosis and prevalent ischemic heart disease (IHD). Significant relationships were found between the amount of standing at work and atherosclerotic progression. After adjustment for the heaviness of the work, psychosocial job factors, income, and biological and behavioral risk factors, the mean change in maximum IMT for those standing not at all, a little, a lot, and very much was 0.24, 0.25, 0.28, and 0.33 mm, respectively. For men with IHD the respective changes were 0.08, 0.15, 0.37, and 0.75 mm -- a 9-fold difference between the no-exposure and high-exposure group. For the men with carotid stenosis, the respective difference was 3-fold. These findings provide the first empirical support in a population study for the role of hemodynamic factors in the progression of atherosclerosis induced by long-term standing. Men with carotid stenosis or IHD appear especially vulnerable to the adverse effects associated with standing at work. Reducing the duration of standing at work should be considered both in the occupational rehabilitation of such patients and in the primary prevention of atherosclerosis.

Negative feelings (discontent) predict progress of intima-media thickness of the common carotid artery in treated hypertensive men at high cardiovascular risk

A number of psychosocial factors have been identified as cardiovascular risk factors. The purpose of the present study was to examine, in a prospective study, whether quality of life, as measured by the minor symptoms evaluation profile, was associated with progression of the intima-media thickness in the common carotid artery in a group of treated hypertensive men at high risk of cardiovascular disease (n = 97). Patients with any cardiovascular disease (myocardial infarction, angina pectoris, intermittent claudication, or stroke) at entry felt significantly more discontent, compared with patients without signs or symptoms of cardiovascular disease. The change in maximum intima-media thickness during the follow-up period was associated with discontent at entry (r = 0.23, P = .03). The relationship between the change in maximum intima-media thickness and discontent at entry remained significant (P = .02) after adjusting for serum-cholesterol and concomitant cardiovascular disease. In conclusion, discontent in treated hypertensive men at high cardiovascular risk was significantly and independently associated with an increase in maximum intima-media thickness in the common carotid artery. This finding suggests that the experience of well-being may influence the atherosclerotic process.