Carotid Intima-Media Thickness is Greater but Carotid Plaque Prevalence is Lower in Black Compared with White Subjects

MacKinnon, Andrew D.; Jerrard-Dunne, Paula; Porteous, L.; Markus, Hugh S.

doi:10.3174/ajnr.a2214

Cited by 22 publications

(22 citation statements)

References 21 publications

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“…A recent meta-analysis of eight observational studies showed that a 0.1 mm higher CIMT was associated with about a 15 % higher risk of CVD [ 8 ]. The mean racial difference in CIMT in our study was only 0.03, and the mean CIMT among Whites was greater than previously reported (0.81 vs. 0.75 mm) [ 17 ]. However, a substantial proportion of Blacks had CIMT >1 mm, compared with Whites, suggesting that the majority of the inter-racial disparity in CIMT may exist at the higher end of the spectrum.…”

Section: Discussioncontrasting

confidence: 89%

“…Previous studies have reported inter-ethnic differences in the burden of CIMT and CAC. For instance, Blacks have a higher CIMT burden than Whites [ 6 , 17 , 18 ], although it is unclear whether this finding correlates with a greater burden of carotid plaque [ 17 ]. In contrast, we and others have reported a lower CAC burden in Blacks [ 9 , 10 , 19 – 21 ], although this finding is controversial [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Racial differences in the burden of coronary artery calcium and carotid intima media thickness between Blacks and Whites

et al. 2014

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BackgroundIdentification of racial differences in the burden and correlates of carotid intima media thickness (CIMT) and coronary artery calcium (CAC) may provide the basis for the development of race-specific cardiovascular disease (CVD) risk prediction algorithms.MethodsIn the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study, CIMT was measured by carotid ultrasonography in 792 individuals (35 % Black). CIMT >1 mm was considered significant. CAC was quantified by electron beam computed tomography in 776 individuals (46 % Black). CAC was considered significant if the Agatston score was >100. Cross-sectional associations between race, CIMT and CAC were assessed using logistic regression models.ResultsBlacks had greater CIMT (mean difference 0.033 mm, 95 % CI 0.005–0.06 mm; p = 0.02) and 1.5-fold (95 % CI 1.0–2.3) higher odds of having significant CIMT than Whites. Blacks had less CAC than Whites (mean Agatston score difference 66, [11–122]; p = 0.02) and 50 % lower odds of a significant CAC score compared with Whites (0.5 [0.3–0.7]). These associations were virtually unchanged after adjustment for CVD risk factors. Of the novel CVD risk markers assessed, small-dense low-density lipoprotein was independently associated with increased odds of significant CIMT, with the association being similar among Blacks and Whites (odds ratio [95 % CI]: 1.7 [1.2–2.5] and 1.4 [1.0–1.8] per 1-SD higher level, respectively). Interleukin-6 was significantly associated with CAC among Blacks (1.4 [1.0–2.0]).ConclusionBlack race is independently associated with greater CIMT but less CAC than White race. CVD risk stratification strategies that incorporate these measures of subclinical atherosclerosis should consider race-specific algorithms.Electronic supplementary materialThe online version of this article (doi:10.1007/s12471-014-0610-4) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Racial differences in the burden of coronary artery calcium and carotid intima media thickness between Blacks and Whites

et al. 2014

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“…Black subjects had significantly greater CIMT and a lower prevalence of carotid plaque than white subjects did, after adjusting for cardiovascular risk factors [ 42 , 44 ]. The discordance of carotid plaque presence and normal CIMT was also observed in other studies [ 45 , 46 ]. Even when CIMT levels are not elevated, more than 30% of subjects have soft or mixed plaque [ 47 ]; of those with CIMT > 1 mm, more than 70% had soft or mixed plaque [ 48 ].…”

Section: Discussionsupporting

confidence: 85%

Features and risk factors of carotid atherosclerosis in a population with high stroke incidence in China

et al. 2017

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Epidemiological studies have reported associations between traditional cardiovascular risk factors and carotid intima-media thickness (CIMT) or carotid plaque. However, definite risk factors at different phases of carotid atherosclerosis remain controversial. We aimed to explore risk factors and characteristics of carotid atherosclerosis at different stages in a low-income population with a high incidence of stroke in China. Between April 2014 and January 2015, we recruited 3789 stroke-free and cardiovascular disease-free residents aged ≥ 45 years. B-mode ultrasonography was performed to measure CIMT and the presence of carotid plaque. Traditional risk factors were compared between the increased CIMT group and normal CIMT group, and between those with and without carotid plaque. A total of 3789 participants were assessed in this study, with a mean age (standard deviation) of 59.92 (9.70) years. The prevalence of increased CIMT and carotid plaque increased with older age and higher education levels. Age, hypertension, diabetes, and high low-density lipoprotein cholesterol levels were risk factors for increased CIMT and carotid plaque. Furthermore, compared to never smoking, passive smoking was positively associated with increased CIMT, with an odds ratio (95% confidence interval) of 1.26 (1.05, 1.53; P = 0.016); high body mass index was an obvious protective factor against carotid plaque, with an odds ratio (95% confidence interval) of 0.97 (0.95, 0.99; P = 0.004). It is important to identify factors associated with atherosclerosis to prevent cardiovascular disease and stroke and reduce the burden of stroke in this high-risk population.

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“…Although IMT and plaques are strongly correlated, they may reflect different biological aspects of atherogenesis 6. A correlation between increased IMT and presence of a carotid plaque was not found in a previous related study 7. Moreover, no significant relationship was found for the contribution of coexisting carotid atherosclerosis to early neurological progression in the present study.…”

Section: Discussioncontrasting

confidence: 81%

Coexisting Carotid Atherosclerosis in Patients with Intracranial Small- or Large-Vessel Disease

et al. 2012

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Background and PurposeThe coexistence of carotid atherosclerosis in ischemic stroke patients with small-vessel disease (SVD) or intracranial large-vessel disease (ICLVD) was investigated using carotid duplex ultrasonography, and whether its coexistence affected the clinical prognosis was determined.MethodsIschemic stroke patients with SVD or ICLVD were enrolled (n=103). Risk factors, demographic data, and National Institutes of Health Stroke Scale (NIHSS) scores were obtained for all of the subjects. Early neurological progression was defined by an increase in NIHSS score during the first 7 days. Carotid ultrasonography was performed to measure the intima-media thickness (IMT) and carotid plaques.ResultsAmong the 103 patients who were retrospectively enrolled in this study (56 with SVD and 47 with ICLVD), 66 (64.1%) had an atherosclerotic plaque and 23 (22.3%) had increased IMT. Increased IMT was observed more frequently in ICLVD than in SVD [15/47 (31.9%) vs. 8/56 (14.3%), p=0.032]. An atherosclerotic plaque was observed on subsequent carotid ultrasonographic examination in 28 (50%) of the 56 patients whose computed tomography angiography scans of the neck vessels were interpreted as normal. There was no association between presence of atherosclerotic change and early neurologic progression (p=0.94).ConclusionsA coexisting atherosclerotic plaque or increased IMT was observed in 71.8% of patients with SVD or ICLVD. Whether the coexistence of carotid atherosclerotic change with either of these conditions affects the clinical prognosis remains to be elucidated.

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Carotid Intima-Media Thickness is Greater but Carotid Plaque Prevalence is Lower in Black Compared with White Subjects

Cited by 22 publications

References 21 publications

Racial differences in the burden of coronary artery calcium and carotid intima media thickness between Blacks and Whites

Racial differences in the burden of coronary artery calcium and carotid intima media thickness between Blacks and Whites

Features and risk factors of carotid atherosclerosis in a population with high stroke incidence in China

Coexisting Carotid Atherosclerosis in Patients with Intracranial Small- or Large-Vessel Disease

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