Common Carotid Artery Intima-media Thickness Values Research Articles

Common carotid artery intima media thickness (CIMT) in patients with prediabetes and newly diagnosed type 2 diabetes mellitus

AimTo evaluate the relationship between common carotid artery intima media thickness (CIMT) in patients with prediabetes and new-onset diabetes mellitus without proven cardiovascular disease and some classic cardio-metabolic risk factors. Patients and methodsThe study included 461 obese patients with an average age of 53.2 ± 10.7 years, divided into three groups - group 1 without carbohydrate disturbances (n = 182), group 2 with prediabetes (n = 193) and group 3 with newly diagnosed diabetes mellitus (n = 86). ResultsThe patients with new-onset diabetes had significantly higher mean CIMT values compared to those with prediabetes or without carbohydrate disturbances and a higher frequency of abnormal IMT values. CIMT correlated significantly with age, systolic BP, diastolic BP and fasting blood glucose and showed a high predictive value for the presence of diabetic neuropathy and sudomotor dysfunction. Patients with abnormal CIMT values had a higher incidence of arterial hypertension, dyslipidemia, metabolic syndrome, peripheral neuropathy, and sudomotor dysfunction. Patients who developed type 2 diabetes during follow-up had a significantly higher initial mean CIMT, which showed the highest predictive value for the risk of new-onset diabetes, with CIMT≥0.7 mm having 53 % sensitivity and 83 % specificity for the risk of progression to diabetes mellitus. ConclusionPatients with new-onset diabetes mellitus had significantly greater intima media thickness of the common carotid artery and a greater frequency of abnormal CIMT values compared to those with normoglycemia and prediabetes. CIMT has a high predictive value for the presence of diabetic neuropathy, sudomotor dysfunction and the risk of new onset diabetes.

Association between serum urate level and carotid atherosclerosis: an insight from a post hoc analysis of the PRIZE randomised clinical trial

ObjectivesElevated serum urate (SU) levels are associated with arterial atherosclerosis and subsequent cardiovascular events. However, an optimal therapeutic target SU level for delaying atherosclerotic progression in patients with hyperuricaemia remains...

The effect of living at high altitude on carotid intima-media thickness in the elderly: a comparative study.

Previous studies have shown that high altitude may have a protective effect on cardiovascular diseases. However, the effects of high altitude on carotid atherosclerosis have been less evidenced. To compare the effect of altitude on atherosclerosis by using carotid artery ultrasonography (CAU) findings. A total of 180 patients aged >60 years, who had proper recorded data of ultrasonography and blood tests, and who resided in the same city for at least five years were included. Patients with anemia, hyperlipidemia, diabetes mellitus, hypertension, and those who did not meet the inclusion criteria were excluded. Patients were divided into two groups: high altitude group (HAG) and sea level group (SLG). CAU findings of each patient-including common carotid artery intima-media thickness (CIMT) ≥1 mm and < 1 mm, internal carotid artery (ICA) stenosis rate, and plaque types-were recorded and compared between the two groups. Blood test parameters and lipid profiles were additionally recorded. Prevalence of patients with CIMT ≥1 mm was significantly higher in the SLG (SLG: 50%, HAG: 15.6%; P < 0.001). Carotid stenosis was found to be significantly different in both groups (HAG: 9.96% ± 23.27%, SLG: 29.83% ± 23.30%; P < 0.001). RBC, HGB, HDL values, and HDL/LDL ratio were found to be significantly higher in the HAG (P < 0.001) whereas LDL, TG, and TC values were significantly higher in the SLG (P < 0.001). People who reside at high altitudes have significantly lower rate of carotid stenosis, lower CIMT values, and less atherogenic lipid profile values, all of which indicate protective effect of high altitude on atherosclerosis.

White-Coat Isolated Systolic Hypertension Is a Risk Factor for Carotid Atherosclerosis.

The clinical importance of white-coat hypertension (WCH) remains a controversial issue. The aim of this study was to evaluate the association of isolated systolic, isolated diastolic, and systolic/diastolic WCH with common carotid artery intima-media thickness (CCA-IMT) and to compare each subgroup of WCH against other blood pressure (BP) phenotypes in terms of CCA-IMT values. A total of 1382 consecutive patients underwent 24-hour ambulatory BP monitoring and carotid artery ultrasonographic measurements. According to the type of elevated office BP, WCH was divided into three groups: isolated systolic, isolated diastolic, and systolic/diastolic WCH. Patients with isolated systolic WCH (n=112) had significantly higher CCA-IMT values (0.737 mm) than those with isolated diastolic WCH (n=66) (0.685 mm) and nonsignificantly greater compared with those with systolic/diastolic WCH (n=228) (0.708 mm). Patients with isolated systolic WCH had CCA-IMT values similar to those with hypertension, patients with isolated diastolic WCH had similar values to those with normotension, and patients with systolic/diastolic WCH had an intermediate risk between normotension and hypertension.

Low Impact of Traditional Risk Factors on Carotid Intima-Media Thickness: The ELSA-Brasil Cohort.

There is little information about how much traditional cardiovascular risk factors explain common carotid artery intima-media thickness (CCA-IMT) variance. We aimed to study to which extent CCA-IMT values are determined by traditional risk factors and which commonly used measurements of blood pressure, glucose metabolism, lipid profile, and adiposity contribute the most to this determination in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort baseline. We analyzed 9792 individuals with complete data and CCA-IMT measurements. We built multiple linear regression models using mean left and right CCA-IMT as the dependent variable. All models were stratified by sex. We also analyzed individuals stratified by 10-year coronary heart disease risk and, in separate, those with no traditional risk factors. Main models' R(2) varied between 0.141 and 0.373. The major part of the explained variance in CCA-IMT was because of age and race. Indicators of blood pressure, lipid profile, and adiposity that most frequently composed the best models were pulse pressure, low-density lipoprotein/high-density lipoprotein ratio, and neck circumference. The association between neck circumference and CCA-IMT persisted significant even after further adjustment for vessel sizes and body mass index. Indicators of glucose metabolism had smaller contribution. We found that >60% of CCA-IMT were not explained by demographic and traditional cardiovascular risk factors, which highlights the need to study novel risk factors. Pulse pressure, low-density lipoprotein/high-density lipoprotein ratio, and neck circumference were the most consistent contributors.

Cardiovascular risk in chronic kidney disease patients: intima-media thickness predicts the incidence and severity of histologically assessed medial calcification in radial arteries.

BackgroundThe objective of the study was to determine the relationship between common carotid artery intima-media thickness (CCA-IMT) and histologically assessed calcification of radial artery in relation to clinical features and laboratory markers of bone and mineral metabolism, inflammation, and oxidative stress in patients with stage 5 chronic kidney disease (CKD).MethodsThe study comprised 59 patients (36 hemodialyzed, 23 predialysis). CCA-IMT was measured by ultrasonography; the biochemical parameters examined were assessed using routine laboratory methods, ELISA micro-plate immunoassays and spectrophotometry. Fragments of radial artery obtained during creation of hemodialysis access were cryosectioned and stained for calcifications using von Kossa method and alizarin red.ResultsGlucose, osteoprotegerin, pentraxin 3 and Framingham risk score significantly correlated with CCA-IMT. In multiple regression analysis, OPG positively predicted CCA-IMT. Radial artery calcifications were found in 34 patients who showed higher CCA-IMT (0.98 ± 0.13 vs 0.86 ± 0.14 mm; P = 0.006). Higher CCA-IMT values were also associated with more advanced calcifications. CCA-IMT and the presence of plaques in common carotid artery were positive predictors of radial artery calcifications, independent of dialysis status, Framingham risk score, CRP and Ca x Pi [OR for calcifications 2.19 (1.08-4.45) per 0.1 mm increase in CCA-IMT]. The presence of radial artery calcifications was a significant predictor of mortality, independent of dialysis status and Framingham risk score [HR 3.16 (1.03-9.64)].ConclusionsIn CKD patients, CCA-IMT examination can be used as a surrogate measure to assess the incidence and severity of arterial medial calcification which is associated with poor clinical outcome in these patients.

PP.18.13

Objective: Several studies have demonstrated that prehypertension is associated with increased target organ damage involvement and cardiovascular risk compared to normotension. However, the impact of short-term blood pressure (BP) variability on target organ damage in prehypertensive subjects has never been investigated. Aim of our study was to evaluate the association of ambulatory BP variability with common carotid artery intima-media thickness (CCA-IMT) in untreated prehypertensive individuals. Design and method: A total of 291 never treated prehypertensive subjects referred for evaluation at the Hypertension Unit of our department, underwent 24-h ambulatory BP monitoring and CCA-IMT ultrasonographic measurements. Prehypertension was defined according to office BP values (120mmHg <= systolic BP < 140mmHg and 80mmHg <= diastolic BP < 90mmHg). Ambulatory BP variability was expressed by standard deviation (SD) of systolic BP and time rate (TR) of systolic BP variation. The study population was dichotomized according to the SD of systolic BP (Low SD group and High SD group) and TR of systolic BP variation levels (Low TR group and High TR group). Statistical analysis was performed by means of independent-samples T test and ANCOVA. Results: Prehypertensive subjects with high TR of systolic BP variation presented significantly (p = 0.001) greater CCA-IMT values (0.744 mm) compared to those with low TR of systolic BP variation (0.686 mm), even after adjustment for demographic characteristics and baseline risk factors. In contrast, CCA-IMT did not differ significantly between prehypertensive individuals with high (0.725 mm) and low SD (0.704 mm) of systolic BP. Conclusions: Prehypertensive subjects with increased TR of systolic BP variation present significantly higher CCA-IMT values compared to those with low TR of systolic BP variation. The assessment of ambulatory BP variability may play an important role for risk stratification of prehypertensive individuals.

Carotid artery remodelling in relation to body fat distribution, inflammation and sustained weight loss in obesity

Obesity is known to be associated with carotid artery remodelling, but less is known about how body fat distribution, inflammation and weight loss may affect this relation. Ultrasonography, dual-energy X-ray absorptiometry and computed tomography were performed to evaluate carotid artery intima-media thickness (IMT), body composition and fat distribution, respectively. Participants were divided into three matched study groups (n = 44 per group): obese patients with sustained weight loss 10 years after bariatric surgery [surgery group, body mass index (BMI) 31.5 kg m(-2)]; obese patients who maintained stable weight during the same time period (obese group, BMI 42.5 kg m(-2)); and normal weight subjects (lean group, BMI 24.4 kg m(-2)). Patients in the surgery group, compared with those in the obese group, had slightly lower common carotid artery (CCA) IMT (0.75 ± 0.18 vs. 0.78 ± 0.17 mm) and common carotid bulb (CCB) IMT (0.92 ± 0.32 vs. 0.97 ± 0.32 mm); however, these differences were not statistically significant. Lean individuals, compared with those in the surgery group, had significantly lower CCA and CCB IMT values (P < 0.001). In forward stepwise multiple regression analyses including all subjects (n = 132), CCA IMT was predicted mainly by visceral adipose tissue, but was also related to blood pressure and levels of triglycerides and high-sensitivity C-reactive protein. Carotid lumen diameter was primarily influenced by lean body mass. Visceral adiposity was the main determinant of premature carotid artery atherosclerosis, possibly through elevated blood pressure, dyslipidaemia and inflammation. Lean body mass predicted carotid artery lumen diameter. Obese patients with long-term sustained weight loss did not have thinner carotid artery walls compared with their weight-stable obese counterparts.

Normative and mean carotid intima-media thickness values according to metabolic syndrome in Koreans: The Namwon Study

ObjectivesWe determined the gender- and age-specific normative values of carotid intima-media thickness (IMT) in a healthy Korean population. We also present the mean age-specific carotid IMT values according to the presence of metabolic syndrome (MetS) and the number of MetS components. MethodsA total of 9374 subjects from the Namwon Study aged 45–74 years were included in the analysis. Subjects without hypertension, diabetes, dyslipidemia, obesity, and current smoking were classified as the healthy reference population (n = 2595). MetS was identified by the presence of three or more of the following five components: abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, high blood pressure, and high fasting blood glucose. Common carotid artery IMT (CCA-IMT) and carotid bulb IMT values were determined in a region free of plaque by B-mode carotid ultrasonography. ResultsThe mean normative CCA-IMT values of 45–49, 50–54, 55–59, 60–64, 65–69, and 70–74 year old males were 0.614, 0.671, 0.711, 0.759, 0.783, and 0.787 mm and 0.613, 0.653, 0.689, 0.718, 0.753, and 0.778 mm for females, respectively. An increase in CCA-IMT of 0.007 mm/year was estimated in both genders. The mean CCA-IMT values of subjects with 0, 1, 2, 3, 4, and 5 MetS components were 0.744, 0.753, 0.765, 0.766, 0.771, and 0.798 mm for males and 0.688, 0.705, 0.724, 0.734, 0.757, and 0.762 mm for females, respectively. ConclusionThe gender-specific normative carotid IMT values were determined in a large healthy Korean population. An increasing trend in the CCA-IMT values was observed with an increasing number of MetS components in both genders.

Age, gender and hypertension as major risk factors in development of subclinical atherosclerosis

Introduction: Intima-media thickness (IMT) measurement of the common carotid artery (CCA) is considered as useful indicator of carotid atherosclerosis. Early detection of atherosclerosis and its associated risk factors is important to prevent stroke and heart diseases. The aim of the present study was to investigate which risk factors are better determinants of subclinical atherosclerosis, measured by common carotidartery intima media thickness (CCA-IMT).Methods: A total of 74 subjects were randomly selected in this cross – sectional study. Information on the patient’s medical history and laboratory fi ndings were obtained from their clinical records. Risk factors relevant to this study were age, gender, cigarette smoking status, diabetes, hypertension and dyslipidemia. Ultrasound scanning of carotid arteries was performed with a 7,5 MHz linear array transducer (GE Voluson730 pro). The highest value of six common carotid artery measurements was taken as the fi nal IMT. Increased CCA-IMT was defi ned when it was &gt; 1 mm.Results: Our data demonstrated higher CCA-IMT values in male patients compared with female patients. Increased CCA-IMT was the most closely related to age (P&lt;0.001), followed by systolic blood pressure (P=0.001), diastolic blood pressure (P=0.003) and glucose blood level (P=0.048).Conclusion: Age, gender and hypertension are the most important risk factors in development of carotid atherosclerosis. Early detection of atherosclerosis among high-risk populations is important in order to prevent stroke and heart diseases, which are leading causes of death worldwide.

Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors

Common carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures. We combined CCIMT data obtained by echotracking on 24 871 individuals (53% men; age range 15-101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n = 4234) used to establish sex-specific equations for percentiles of CCIMT across age. With these equations, we generated CCIMT Z-scores in different reference sub-populations, thereby allowing for a standardized comparison between observed and predicted ('normal') values from individuals of the same age and sex. In the sub-population without CVD and treatment (n = 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized βs 0.19 (95% CI: 0.16-0.22) and 0.18 (0.15-0.21)], smoking [0.25 (0.19-0.31) and 0.11 (0.04-0.18)], diabetes [0.19 (0.05-0.33) and 0.19 (0.02-0.36)], total-to-HDL cholesterol ratio [0.07 (0.04-0.10) and 0.05 (0.02-0.09)], and body mass index [0.14 (0.12-0.17) and 0.07 (0.04-0.10)]. We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CV-RFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings.

Evaluation of the Future Atherosclerotic Heart Disease with Oxidative Stress and Carotid Artery Intima Media Thickness in Gestational Diabetes Mellitus

Background and objective. In this study our aim was to evaluate paraoxonase (PON1) activity and free sulfhydryl groups (–SH) as antioxidative parameters and lipid hydroperoxide (LOOH) as oxidative parameter in the serum of women with gestational diabetes mellitus (GDM) and determine their relation with the degree of subclinical atherosclerosis. Material and methods. Serum samples from 39 pregnant women complicated with GDM and 40 healthy pregnant women were collected for the analysis of oxidative markers. Common carotid artery intima media thickness (CIMT) was measured for both groups to assess future atherosclerotic heart disease risk. PON1 activity and –SH were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with a xylenol orange assay. Results. CIMT and LOOH levels were significantly higher (p = 0.01, p < 0.001, respectively) in GDM group compared to controls, whereas PON1 and –SH levels were significantly lower (p < 0.001 for both). CIMT values were significantly correlated with body mass index (BMI), 50 g oral glucose tolerance test (OGTT), and mean arterial blood pressure (MABP) (p = 0.003, p = 0.02, and p = 0.03, respectively). However, there was no correlation between CIMT and oxidative markers. Conclusions. Increased levels of LOOH and decreased levels of PON1 and –SH showed disturbance of antioxidative mechanisms in GDM. These changes were associated with increased BMI and MABP which may be relevant to GDM pathophysiology. Furthermore, increased CIMT values in GDM compared to healthy controls designate increased risk of future atherosclerotic heart disease.

Obesity phenotype and cardiovascular changes

Healthy obese phenotype with favorable metabolic profiles is proposed. However, whether healthy obesity leads to target organ changes is controversial. We investigated the impact of a healthy obesity on cardiovascular structure and function. A total of 2540 participants without known cardiovascular disease were enrolled. According to BMI and the metabolic syndrome (MetS) component, the participants were divided into six groups: healthy (none of five MetS components) normal weight (BMI <23 kg/m²), unhealthy (one or more of five MetS components) normal weight, healthy overweight (BMI 23-24.9 kg/m²), unhealthy overweight, healthy obesity (BMI ≥25 kg/m²), and unhealthy obesity. The cardiovascular changes were assessed by echocardiography, tissue Doppler imaging (TDI), carotid ultrasonography, and pulse wave velocity (PWV). In a multivariate analysis after adjusting for age, sex, heart rate, high-sensitivity C-reactive protein, and medication for hypertension and diabetes mellitus, the unhealthy overweight and obese groups showed statistically significant changes in the left ventricular mass index, mitral E/A ratio, E/Ea ratio, TDI Ea velocity, common carotid artery intima-media thickness (CCA-IMT), and brachial-ankle PWV (P < 0.001), compared with the healthy normal weight individuals. In the healthy overweight and obese groups, CCA-IMT and brachial-ankle PWV values were similar, but left-ventricular mass index and TDI Ea velocity were significantly different (P < 0.001). Healthy obesity was associated with subtle changes in left ventricular structure and function. These data provide evidence that metabolically healthy phenotypes with excess weight may not be a benign condition.

Impact of prehypertension on carotid artery intima–media thickening: Actual or masked?

BackgroundRecent studies have reported that prehypertension is associated with increased values of common carotid artery intima–media thickness (CCA-IMT). The aim of this study was to assess the impact of daytime ambulatory blood pressure (BP) levels on the association of prehypertension with CCA intima–media thickening in prehypertensive subjects. MethodsA total of 807 subjects with office systolic BP<140 and diastolic BP<90mmHg, underwent 24h ambulatory BP (ABP) monitoring and carotid artery ultrasonographic measurements. The study population was divided into 3 groups according to office and daytime ABP levels: (1) normotensives: subjects with office BP<120/80mmHg and daytime ambulatory BP values within the normal range, (2) actual prehypertensives: individuals with office SBP (120–139mmHg) and/or DBP (80–89mmHg) and daytime ambulatory BP values within the normal range and (3) prehypertensives with masked hypertension (MH): patients with office SBP (120–139mmHg) and/or DBP (80–89mmHg) and elevated daytime ambulatory BP values. ResultsPrehypertensive patients with MH had higher (p<0.01) CCA-IMT values (0.712mm; 95%CI: 0.698–0.725) than actual prehypertensives (0.649mm; 95%CI: 0.641–0.656) and normotensives (0.655mm; 95%CI: 0.641–0.670) even after adjustment for baseline characteristics. Normotensives and actual prehypertensives did not differ significantly regarding CCA-IMT values (p>0.05). After adjusting for potential confounders, (including demographic characteristics, vascular risk factors, and office BP) prehypertension with MH was independently (p<0.01) associated with a 0.06mm increment in CCA-IMT (95%CI: 0.03–0.09). ConclusionsPatients with office BP levels in the prehypertensive range, who also have elevated daytime ABP levels, had higher CCA-IMT values than patients with prehypertension with normal daytime ABP values and normotensive individuals.

Common Carotid Artery Intima-Media Thickness: The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) Study Results

Background: Measurement of far wall common carotid artery intima-media thickness (CCAIMT) has emerged as a predictor of incident cardiovascular events. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was the first large-scale population-based assessment of both CCAIMT and cardiovascular risk factor prevalence in 7 Latin American cities; the relationship between CCAIMT and cardiovascular risk markers was assessed in these urban Latin American centers. Methods: CARMELA was across-sectional, population-based, observational study using stratified, multistage sampling. The participants completed a questionnaire, were evaluated in a clinical visit and underwent carotid ultrasonography. Clinical measurements were obtained by health personnel trained, certified and supervised by CARMELA investigators. Mannheim intima-media thickness consensus guidelines were followed for measurement of CCAIMT. Results: In all cities and for both sexes, CCAIMT increased with higher age. CCAIMT was greater in the presence of cardiovascular risk factors than in their absence. In all cities, there was a statistically significant linear trend between increasing CCAIMT and a growing number of cardiovascular risk factors (p < 0.001). After adjustment for age and sex, metabolic syndrome was strongly associated with increased CCAIMT (p < 0.001 in all cities), as were hypercholesterolemia, obesity and diabetes (p < 0.001 in most cities). By multivariate analysis, hypertension was independently associated with an increase in CCAIMT in all cities (p < 0.01). Conclusions: CARMELA was the first large-scale population study to provide normal CCAIMT values according to age and sex in urban Latin American populations and to show CCAIMT increases in the presence of cardiovascular risk factors and metabolic syndrome.

IMPAIRED BARORECEPTOR SENSITIVITY IS ASSOCIATED WITH INCREASED COMMON CAROTID ARTERY INTIMA-MEDIA THICKNESS IN HYPERTENSIVE PATIENTS: PP.2.88

Objective: Recent studies have clearly demonstrated that hypertension, even in early stages, is associated with impaired baroreceptor reflex sensitivity (BRS). Common carotid artery intima-media thickness (CCA-IMT) represents a surrogate marker of subclinical atherosclerosis. Aim of our study was to evaluate the relationship between BRS and CCA-IMT in hypertensive subjects. Design and Method: A total of 15 untreated hypertensive patients underwent 24-hour ambulatory blood pressure (BP) monitoring and carotid ultrasonographic measurements. All patients underwent a 15-min electrocardiographic and non-invasive BP monitoring (Finometer). Cardiac BRS was calculated from the combined a-index. Subjects with daytime ambulatory BP values more than 135/85 mmHg were defined as hypertensives. Statistical analysis was performed by means of bivariate correlations. Results: The mean age of the study population was 52 ± 11 years. The mean daytime systolic and diastolic ambulatory BP values were 145 ± 13 mmHg and 90 ± 9 mmHg, respectively. The CCA-IMT was 0.71 ± 0.16 mm and the combined a-index was 3.32 ± 1.60 ms/mmHg. CCA-IMT values were significantly correlated with the combined a-index (r = −0.590, p = 0.021). Conclusions: Our finding suggests that impaired BRS is significantly correlated with increased CCA-IMT values in hypertensive patients.

Measurement of Common Carotid Artery Intima-Media Thickness in Clinical Practice: Comparison of B-Mode and RF-Based Technique

The common carotid artery intima-media thickness (CCA-IMT) is usually measured using B-mode ultrasound images. A different approach for CCA-IMT detection is based on radio frequency (RF) multiple M-line analysis. The present study explores the relationship between B-mode and RF measurement of CCA-IMT, as well as the reproducibility of both methods in 136 patients recently diagnosed with cardiovascular disease. Within one session, repeated measurements were made in the distal CCA bilaterally, using the B-mode (averaged over 10 mm) and RF technique (averaging 12 M-lines over 14 mm). The two methods correlate well (Pearson r = 0.765). The CCA-IMT values measured with B-mode and RF were 0.779 +/- 0.196 mm and 0.734 +/- 0.172 mm, respectively. B-mode CCA-IMT is significantly larger than RF CCA-IMT (mean difference of 0.045 mm, SEM 7.8 microm; t = 5.82; p < 0.001). In the multivariate regression analysis, carotid artery stenosis, inhomogeneous IMT and diabetes mellitus were the main predictors of differences between B-mode and RF CCA-IMT. The intrapatient variation for B-mode and RF-based CCA-IMT is comparable (0.05 +/- 0.04 mm and 0.07 +/- 0.05 mm, respectively). CCA-IMT values measured with RF and B-mode have similar reproducibility and exhibit acceptable correlation, but RF CCA-IMT is significantly smaller. The difference between both methods is mainly due to advanced atherosclerosis. Hence, both methods can be used reliably to measure CCA-IMT in clinical practice.

Association of Blood Pressure Levels with Carotid Intima-Media Thickness and Plaques

The aim of this study was to investigate the association of blood pressure levels with the common carotid artery intima-media thickness (CCA-IMT) and carotid plaques. Data were obtained from 2,635 subjects, aged 50 years and over, who participated in the Community Health Survey (a population-based, cross-sectional study) in Dong-gu, Gwangju city between 2007 and 2008. Participants were categorized into three groups according to blood pressure levels; normotensives (<120/80 mmHg), prehypertensives (120-139/80-89 mmHg), and hypertensives (> or =140/90 mmHg). Prehypertensives were further categorized as low prehypertensives (120-129/80-84 mmHg) and high prehypertensives (130-139/85-89 mmHg). Carotid intima-media thickness and plaques were evaluated with a high-resolution B-mode ultrasound. Statistical analyses were performed using chi-square test, ANOVA, and multiple logistic regression. Prehypertensives had significantly greater maximal CCA-IMT values than normotensives, with a multivariate adjusted odds ratio of 1.78 (95% CI=1.36-2.32) for abnormal CCA-IMT (maximal CCA-IMT > or =1.0 mm), and 1.45 (95% CI=1.19-1.77) for carotid plaques. The multivariate adjusted odds ratio of low prehypertensives was 1.64 (95% CI=1.21-2.21) for abnormal CCA-IMT, and 1.30 (95% CI=1.04-1.63) for carotid plaques compared with normotensives. Subject with hypertension had higher frequency of abnormal CCA-IMT (odds ratio, 2.18; 95% CI=1.49-3.18), and carotid plaques (odds ratio, 1.98; 95% CI=1.46-2.67) compared with normotensives after adjustment for other cardiovascular risk factors. Our results indicate that there is a significant increase in the prevalence of carotid atherosclerosis in subjects with prehypertension (even in low prehypertensives) compared with normotensive subjects. Further studies are required to confirm the benefits and role of carotid ultrasonography in persons with prehypertension.

Common Carotid Artery Intima-Media Thickness: Towards a Definition of Abnormal Values in Symptomatic Cerebrovascular Disease

To the Editor: We welcome the recent article by Tsivgoulis and colleagues showing that higher values of common carotid artery intima-media thickness (CCA-IMT) may represent an independent risk factor for stroke recurrence.1 We reached the same conclusion after carrying out a study, independently planned and executed in a different geographical area in Greece.2 We had previously shown that increased CCA-IMT values are independently associated with de novo development of cognitive impairment during the first year after their stroke.3 These results suggest that CCA-IMT measures may be of clinical use in the long-term management of stroke patients. We would, therefore, like to raise a few issues. In our study, 284 patients with first ever ischemic stroke were followed up …

Common Carotid Artery Intima-Media Thickness and the Risk of Stroke Recurrence

Increased common carotid artery intima-media thickness (CCA-IMT) has been associated with an increased risk of myocardial infarction and stroke. We investigated the relationship between CCA-IMT and recurrent stroke in a cohort of ischemic stroke patients. High-resolution B-mode ultrasonographic measurements of the CCA-IMT were performed in a consecutive series of 238 patients hospitalized in our institution with first-ever ischemic stroke. Stroke risk factors and secondary prevention therapies were documented. Patients were followed-up prospectively and the outcome event of interest was recurrent stroke. During a mean follow-up period of 28.9 months (range: 6 to 60 months), 27 recurrent strokes were documented. Patients who experienced recurrent cerebrovascular events had significantly (P=0.005) higher CCA-IMT values (1.01 mm, 95% CI:0.92 to 1.11 mm) than subjects who were free of stroke recurrence (0.88 mm, 95% CI:0.85 to 0.91 mm). After adjustment for baseline characteristics, risk factors and stroke subtypes and secondary prevention therapies increasing CCA-IMT was found to be an independent predictor of stroke recurrence. For each increment of 0.1 mm in CCA-IMT the probability of experiencing recurrent stroke increased by 18.0% (95% CI:2.0% to 36.0%, P=0.027). Increased CCA-IMT values are associated with a higher risk of long-term stroke recurrence.