Background and Purpose-Data on risk factors for progression of intima-media thickness (IMT) and plaque are scarce.The objective was to determine long-term risk factors for total plaque area (TPA) and IMT as well as risk factors for progression (⌬TPA and ⌬IMT). Methods-Subjects were 1307 men and 1436 women who participated in a longitudinal population-based study with ultrasound examination of the right carotid artery at baseline and after 13 years of follow-up. Total cholesterol, high-density lipoprotein cholesterol, blood pressure, body mass index, and information about smoking habits, prevalent diabetes, and cardiovascular disease were obtained at baseline. Carotid atherosclerosis was assessed as TPA and mean IMT of plaque-free segments of the common carotid artery. Associations between z-scores of risk factors and carotid atherosclerosis were assessed in multiple linear regression models. Results-In multivariable models, total cholesterol, systolic blood pressure, and smoking were stronger predictors of follow-up TPA than of IMT, whereas sex and age were stronger predictors of IMT. Total cholesterol (standardized ␤ϭ0.081), systolic blood pressure (standardized ␤ϭ0.062), and smoking (standardized ␤ϭ0.107) were significant predictors of ⌬TPA, whereas only total cholesterol (standardized ␤ϭ0.084) was an independent predictor of ⌬IMT. The variance explained by traditional cardiovascular risk factors was somewhat greater for TPA than for IMT. Conclusions-The cardiovascular risk factors total cholesterol, smoking, and systolic blood pressure were stronger long-term predictors of TPA and TPA progression than for IMT and IMT progression. Key Words: carotid atherosclerosis Ⅲ progression Ⅲ risk factors Ⅲ ultrasonography C arotid intima-media thickness (IMT) and plaque are frequently used as a proxy for cardiovascular diseases in observational and interventional studies. [1][2][3] However, in recent years it has been come increasingly clear that IMT and plaque show different relationships to cardiovascular risk factors as well as clinical end points. According to guidelines, IMT is preferably measured in plaque-free segments of the far wall of the distal common carotid artery (CCA-IMT). 4 CCA-IMT is strongly related to age and hypertension, and thickening of the intima-media layer mainly represents a hypertrophic adaptive response of smooth muscle cells in the tunica media to high shear stress. 5,6 Plaques usually occur at sites of low shear and nonlaminar turbulent flow such as in the carotid bulb and the proximal internal carotid artery, 6 and is rare in the distal CCA. The role of IMT as a marker of atherosclerosis has been questioned, especially when measurements include the CCA-IMT only. 7 Carotid plaque burden can be measured as a continuous variable as the sum of all plaque areas in the artery, the total plaque area (TPA). TPA has been found to be more strongly associated with traditional cardiovascular risk factors than CCA-IMT. 5,8 TPA has also been found to be a stronger predictor of coronary artery disease ...

A reduced glomerular filtration rate (GFR) in chronic kidney disease is a risk factor for cardiovascular disease. However, evidence indicates that a high GFR may also be a cardiovascular risk factor. This issue remains unresolved due to a lack of longitudinal studies of manifest cardiovascular disease with precise GFR measurements. Here, we performed a cross-sectional study of the relationship between high GFR measured as iohexol clearance and subclinical cardiovascular disease in the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6), a representative sample of the middle-aged general population. A total of 1521 persons without cardiovascular disease, chronic kidney disease, diabetes, or micro- or macroalbuminuria were examined with carotid ultrasonography and electrocardiography. The GFR in the highest quartile was associated with an increased odds ratio of having total carotid plaque area greater than the median of non-zero values (odds ratio 1.56, 95% confidence interval 1.02-2.39) or electrocardiographic signs of left ventricular hypertrophy (odds ratio 1.62, 95% confidence interval 1.10-2.38) compared to the lowest quartile. The analyses were adjusted for cardiovascular risk factors, urinary albumin excretion, and fasting serum glucose. Thus, high GFR is associated with carotid atherosclerosis and left ventricular hypertrophy and should be investigated as a possible risk factor for manifest cardiovascular disease in longitudinal studies.

BackgroundThe metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease. In this study, we examine if metabolic syndrome predicts progression of atherosclerosis over 13 years.MethodsParticipants were 1442 men and 1532 women in the population-based Tromsø Study who underwent carotid ultrasound examinations at baseline in the 4th (1994–5) and at follow-up in the 6th survey (2007–8). Of these, 278 men and 273 women fulfilled the criteria for the MetS, defined according to a modified version of the National Cholesterol Education Program Adult Treatment Panel III (NCEP, ATPIII). Carotid atherosclerosis was assessed as total plaque area (TPA) and mean intima-media thickness (IMT) at follow-up and as change in IMT and TPA from baseline to follow-up. Associations between MetS and its components and carotid atherosclerosis were assessed in linear regression models adjusted for age, total cholesterol and daily smoking, stratified by sex.ResultsIMT and TPA levels at follow-up (p < 0.0001) and progression of TPA (p = 0.02) were higher in the MetS group compared to the non-MetS group. In stepwise multivariable models, MetS was associated with TPA (β = 0.372 mm2, p = 0.009) and IMT (β = 0.051 mm, p < 0.0001) in men, and with IMT (β = 0.045 mm, p = 0.001) in women after 13 years of follow-up, but not with progression of IMT or TPA. In analyses stratified by age, MetS predicted progression of IMT (β = 0.043 mm, p = 0.046) and TPA (β = 1.02 mm2, p = 0.002) in men below 50 years of age. Hypertension was predictive of follow-up TPA and IMT in both genders and of progression of TPA in women. Impaired glucose tolerance was associated with follow up levels of IMT and TPA as well as progression in IMT in men. None of the other components of MetS were associated with progression of atherosclerosis.ConclusionsSubjects with MetS had higher levels of IMT and TPA at follow up than those without MetS. Mets predicted progression of IMT and TPA in those below 50 years of age, but not in other age groups, indicating that MetS may be involved in the initiation of the atherosclerotic process.