Carotid Intima-Media Thickness and Plaque Characteristics as a Risk Factor for Stroke in Japanese Elderly Men

Abstract

Background and Purpose-Few cohort studies have examined the association of carotid intima-media thickness (IMT) and plaque characteristics with the risk of stroke in apparently healthy persons. We examined the relationship of carotid IMT and the surface, morphology, and calcification of carotid plaques with the incidence of stroke among Japanese men. Methods-Carotid IMT and plaque were evaluated bilaterally with ultrasonography in 1289 men aged 60 to 74 years without a previous stroke or coronary heart disease. In this cohort, the subsequent incidence of stroke was investigated. Results-During the 4.5-year follow-up, 34 strokes occurred. The multivariate-adjusted relative risk (95% CI) for the highest versus lowest quartiles of maximum IMT of the common carotid artery (CCA; Ն1.07 versus Յ0.77 mm) was 3.0 (1.1 to 8.3) for stroke. The combination of CCA and internal carotid artery (ICA) wall thickness was a better predictor of the risk of stroke than was CCA wall thickness alone. Men with a plaque, defined as a focal wall thickness of Ն1.5 mm, in the ICA had a 3-fold higher risk of stroke than those without a plaque, and the plaque surface irregularity further increased the stroke risk. A significant excess risk of stroke was confined to men with an uncalcified plaque. Key Words: atherosclerosis Ⅲ carotid artery Ⅲ epidemiology Ⅲ risk factors Ⅲ stroke P rospective population-based studies in Europe and the United States have documented that carotid intima-media thickness (IMT) and plaque are positively associated with the subsequent incidence of stroke. 1-4 Furthermore, 2 prospective studies have investigated the association between echogenicity of plaques or carotid artery lesions and stroke risk in American populations; 1 study indicated that hypoechoic plaque was associated with increased risk of ischemic stroke, 5 and the other study implied that acoustic shadowing on carotid artery lesions is predictive of ischemic stroke. 6 In Asian countries, a previous follow-up study of Japanese patients with cardiovascular diseases or high-risk profiles showed a positive association between the severity of carotid plaque and the risk of ischemic stroke, 7 but no prospective study has been conducted in a general population. The aim of this prospective study was to systematically examine the incidence of stroke in relation to carotid IMT and the surface, morphology, and calcification of carotid plaque in community-dwelling Japanese elderly men. Conclusions-Increased Subjects and Methods Study PopulationSubjects comprised 1358 men aged 60 to 74 years who were all participants of the target ages in a cardiovascular risk survey between 1996 and 2000. Subjects lived in 1 urban and 2 rural communities in Japan (Minamitakayasu district in Yao City, an urban community in Osaka Prefecture, 278 miles west of Tokyo, with a total census of 23 552 in 2000; Ikawa town, a rural community in Akita Prefecture, 280 miles northeast of Tokyo, with a total census of 6116; and Noichi town, a rural community in Kochi Prefecture, 393 miles sout...

Association between Carotid Hemodynamics and Asymptomatic White and Gray Matter Lesions in Patients with Essential Hypertension

“…The Cardiovascular Health Study previously demonstrated strong relationships between white matter lesions and carotid IMT and stenosis (37). Kitamura et al reported that increased IMT is a risk factor for stroke in Japanese elderly men (38). In the present study, PVH, DSWMH, and état criblé were positively associated with the IMT.…”

“…Second, we did not evaluate the maximum IMT of the internal carotid artery (ICA). In their cohort study, Kitamura et al reported that the combination of CCA and ICA wall thickness was a better predictor of the risk of stroke than was CCA wall thickness alone (38). Further study is needed to clarify the relationship between the max IMT of ICA and asymptomatic MRI findings.…”

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“…Accumulating evidence suggests that measurement of endothelial function and carotid IMT can be predictive of cardiovascular and stroke events. 12,20,21 At this time, it remains unclear whether omentin acts as a predictive factor for the vascular outcomes, and this analysis requires future prospective studies.…”

Ultrasound Detection of Increased Carotid Intima-Media Thickness and Carotid Plaque in an Office Practice Setting: Does It Affect Physician Behavior or Patient Motivation?

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