Carotid Intima-Media Thickness and Plaque in Cardiovascular Risk Assessment

Abstract

Carotid intima-media thickness (CIMT) has been shown to predict cardiovascular (CV) risk in multiple large studies. Careful evaluation of CIMT studies reveals discrepancies in the comprehensiveness with which CIMT is assessed-the number of carotid segments evaluated (common carotid artery [CCA], internal carotid artery [ICA], or the carotid bulb), the type of measurements made (mean or maximum of single measurements, mean of the mean, or mean of the maximum for multiple measurements), the number of imaging angles used, whether plaques were included in the intima-media thickness (IMT) measurement, the report of adjusted or unadjusted models, risk association versus risk prediction, and the arbitrary cutoff points for CIMT and for plaque to predict risk. Measuring the far wall of the CCA was shown to be the least variable method for assessing IMT. However, meta-analyses suggest that CCA-IMT alone only minimally improves predictive power beyond traditional risk factors, whereas inclusion of the carotid bulb and ICA-IMT improves prediction of both cardiac risk and stroke risk. Carotid plaque appears to be a more powerful predictor of CV risk compared with CIMT alone. Quantitative measures of plaques such as plaque number, plaque thickness, plaque area, and 3-dimensional assessment of plaque volume appear to be progressively more sensitive in predicting CV risk than mere assessment of plaque presence. Limited data show that plaque characteristics including plaque vascularity may improve CV disease risk stratification further. IMT measurement at the CCA, carotid bulb, and ICA that allows inclusion of plaque in the IMT measurement or CCA-IMT measurement along with plaque assessment in all carotid segments is emerging as the focus of carotid artery ultrasound imaging for CV risk prediction.

Distinct Longitudinal Associations of MBL, MASP-1, MASP-2, MASP-3, and MAp44 With Endothelial Dysfunction and Intima–Media Thickness

“…26 cIMT reflects pathological changes in the vessel wall that may result from early atherosclerosis and also from aging of the vessel wall. [22][23][24] High MBL may protect from intimalmedial thickening via its beneficial role in vascular clearup processes and tissue turnover. 7 Importantly, cIMT does not reflect the presence of atherosclerotic plaques.…”

“…We investigated their longitudinal associations with biomarker scores that reflect low-grade inflammation and endothelial dysfunction and with cIMT as a marker of subclinical vascular disease. [22][23][24] Furthermore, we determined their associations with incident CVD and incident CVEs over a 7-year follow-up period. Previous studies suggested that the effects of lectin-pathway activation in CVD could be both beneficial and adverse.…”

Carotid Atherosclerosis Progression and Risk of Cardiovascular Events in a Community in Taiwan

“…A meta-analysis also revealed improved accuracy for predicting risk of coronary events when IMT measurement consisted of not only CCA but also other segments, in which plaques are more prevalent, suggesting the importance of incorporating plaque assessment in extracranial carotid artery for risk prediction 10 . A substantial amount of epidemiological evidence has shown that quantification of plaque burden, measured by ultrasonography, is a stronger predictor of cardiovascular endpoints than is IMT 9,10,16,17 . However, limited data is available on the association between plaque progression and cardiovascular outcomes.…”

Arterial hypertension, obesity and non-alcoholic fatty liver disease: is there any connection?

“…It was repeatedly noted that TIMC increase and the presence of atherosclerotic plaques of the carotid arteries might be a predictor of myocardial infarction (MI) and stroke. The ratio of TIMC and CV risk is continuum, but the criterion for a significant risk increase may be the threshold of TIMC equalled to 0.9 mm and more [110][111][112]. The value of fat steatohepatosis as an additional CV risk factor was confirmed by studies of Marcucci et al (2010).…”