Carotid Arterial Wall Characteristics Are Associated With Incident Ischemic Stroke But Not Coronary Heart Disease in the Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background and Purpose Ultrasound measurements of arterial stiffness are associated with atherosclerosis risk factors, but limited data exist on their association with incident cardiovascular events. We evaluated the association of carotid ultrasound derived arterial stiffness measures with incident coronary heart disease (CHD) and ischemic stroke in the ARIC study. Methods Carotid arterial strain (CAS) and compliance (AC), distensibility (AD) and stiffness indices (SI), pressure-strain (Ep) and Young’s elastic moduli (YEM) were measured in 10,407 individuals using ultrasound. Hazard ratios for incident CHD (myocardial infarction [MI], fatal CHD, coronary revascularization) and stroke in minimally adjusted (age, sex, center, race) and fully adjusted models (minimally adjusted model + diabetes, height, weight, total cholesterol, high-density lipoprotein cholesterol, tobacco use, systolic blood pressure, antihypertensive medication use, and carotid intima-media thickness (CIMT) were calculated. Results The mean age was 55.3 years. Over a mean follow up of 13.8 years, 1,267 incident CHD and 383 ischemic stroke events occurred. After full adjustment for risk factors and CIMT, all arterial stiffness parameters [CAS HR (95% confidence interval [CI]) =1.14 (1.02, 1.28); AD HR=1.19 (1.02, 1.39); SI HR=1.14 (1.04, 1.25); Ep HR=1.17 (1.06, 1.28); YEM HR=1.13 (1.03, 1.24)], except arterial compliance HR=1.02 (0.90, 1.16), were significantly associated with incident stroke but not with CHD. Conclusions After adjusting for cardiovascular risk factors, ultrasound measures of carotid arterial stiffness are associated with incident ischemic stroke but not incident CHD events, despite that the 2 outcomes sharing similar risk factors.

Sex-Specific Association of Age with Carotid Artery Distensibility: Multi-Ethnic Study of Atherosclerosis

“…Also, the age-sex interaction in DC means that older women have stiffer arteries than older men. To give a sense of the magnitude of the differences, we use the unadjusted hazard ratios for stroke associated with lower distensibility reported by Yang et al 7 : because of differences in DC, women who are 10 years older would have a 30.4% higher hazard of stroke than their younger counterparts, whereas men with the same age difference would have a 25.6% higher hazard of stroke. In addition, the afterload on the heart of older women is likely to be greater than that among older men.…”

Effect of Low-and High-Dose Atorvastatin on Carotid Artery Distensibility Using Carotid Magnetic Resonance Imaging ^|^mdash;A Post-Hoc Sub Group Analysis of ATHEROMA (Atorvastatin Therapy: Effects on Reduction of Macrophage Activity) Study

“…Statins are known to have a number of immunomodulatory effects which may affect arterial stiffness [11][12][13][14] and plaque stability 15,16) . Ultrasound-based techniques have been used for non-invasive assessment of the distensibility of arteries, such as the carotid artery, which is fairly superficial in its location 17) . Despite being a quicker and rela-…”

The Relationship of Carotid Arterial Stiffness and Left Ventricular Concentric Hypertrophy in Hypertension

“…Ultrasound--based carotid stiffness measurements are valuable because they make it possible to determine arterial stiffness in the vessel with the most relevance to particular cerebrovascular outcomes. It was recently shown that local carotid stiffness had independent predictive value for incident stroke, but not for coronary heart disease [25]. In the present study, carotid arterial stiffness was assessed in patients with concentric hypertrophy -the pattern associated with a higher prevalence of carotid atherosclerosis and cerebrovascular events.…”