Combination of carotid intima-media thickness and plaque for better predicting risk of ischaemic cardiovascular events

Xie, Weixin; Liang, Lirong; Zhao, Liyan; Shi, Peng; Yang, Ying; Xie, Gaoqiang; Huo, Yong; Wu, Yangfeng

doi:10.1136/hrt.2011.223032

Cited by 60 publications

(45 citation statements)

References 31 publications

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“…‘total burden of carotid atherosclerosis', predicts cardiovascular and cerebrovascular events better [24]. Other studies have found certain plaque characteristics to predict cardiovascular events [25,26].…”

Section: Discussionmentioning

confidence: 99%

Increased Carotid Intima-Media Thickness and Plasma Homocysteine Levels Predict Cardiovascular and All-Cause Death: A Population-Based Cohort Study

et al. 2013

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Background: There is still debate over the utility of carotid intima-media thickness (C-IMT) or carotid plaque in predicting future cardiovascular events and death. Additionally, the importance of plasma homocysteine levels was raised as a predictor of cardiovascular events and death. Methods: 1,391 subjects were recruited from the Ansan Geriatric cohort. We used B-mode carotid ultrasonography to assess C-IMT and plaque, measuring average maximal IMT and average mean IMT through 6-8 measurements of far-wall IMT in both common carotid arteries. We evaluated the presence of plaque in carotid segments. Multivariable Cox regression analysis was used to predict both cardiovascular and all-cause mortality. Results: During a mean follow-up of 62.4 ± 12.4 months, 71 subjects (5.12%) died and 23 (1.66%) died of cardiovascular causes. Multivariable Cox regression analysis found the predictors of cardiovascular mortality to be average maximal IMT (HR = 3.709; 95% CI: 1.202-11.446) and plasma homocysteine (HR = 1.057; 95% CI: 1.012-1.103). All-cause mortality was independently associated with C-IMT (average maximal and average mean IMT) and plasma homocysteine. Conclusions: C-IMT and plasma homocysteine levels were found to predict cardiovascular and all-cause mortality independently of the presence of carotid plaque and other cardiovascular risk factors.

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Section: Discussionmentioning

confidence: 99%

Increased Carotid Intima-Media Thickness and Plasma Homocysteine Levels Predict Cardiovascular and All-Cause Death: A Population-Based Cohort Study

et al. 2013

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“…Both have been shown to be of incremental value in risk prediction among symptomatic patients, but studies are generally lacking on the utility of incorporating them into risk scores for use among asymptomatic people. Carotid intimamedia thickness is a significant predictor of the risk of cardiovascular events in individuals without carotid plaques (27). When combined with information on the number of segments with plaque, to produce a total burden of carotid atherosclerosis score, the c statistic and net reclassification index are improved by 6.0% and 17.1%, respectively.…”

Section: Do Biomarkers Add Value?mentioning

confidence: 94%

Almanac 2012: cardiovascular risk scores. The journals present selected research that has driven recent advances in clinical cardiology

Pell¹

2013

AnadoluKardiyolDerg

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Acknowledgement of permission for re-publication: The article was first published in Heart (Pell JP. Almanac 2012: cardiovascular risk scores. The national society journals present selected research that has driven recent advances in clinical cardiology. Heart. 2012 Sep;98(17):1272-7. doi: 10.1136/heartjnl-2012 and is republished with permission. Jill P. PellInstitute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ-UK ABSTRACT Global risk scores use individual level information on non-modifiable risk factors (such as age, sex, ethnicity and family history) and modifiable risk factors (such as smoking status and blood pressure) to predict an individual's absolute risk of an adverse event over a specified period of time in the future. Cardiovascular risk scores have two major uses in practice. First, they can be used to dichotomise people into a group whose baseline risk, and therefore potential absolute benefit, is sufficiently high to justify the costs and risks associated with an intervention (whether treatment or prevention) and a group with a lower absolute risk to whom the intervention is usually denied. Second, they can be used to assess the effectiveness of an intervention (such as smoking cessation or antihypertensive treatment) at reducing an individual's risk of future adverse events. In this context, they can be helpful in informing patients, motivating them to change their lifestyle, and reinforcing the importance of continued compliance.

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“…Carotid intimamedia thickness (cIMT) is well established as a predictor of cardiovascular events in the general population and, more weakly, in patients with stable coronary artery disease (80). Its predictive value may be enhanced by additional consideration of the extent of carotid plaque allowing derivation of the 'total burden score' which was shown by Chinese investigators to improve the prediction of the 5-year risk of cardiovascular endpoints compared with cIMT alone (81). Certainly, the value of cIMT alone for cardiovascular risk prediction in the general population is under question following a large meta-analysis of participant-level data in 45 828 individuals in which cIMT added almost nothing to the Framingham Risk Score (82).…”

Section: Secondary Prevention Of Stable Coronary Diseasementioning

confidence: 99%

Almanac 2013-stable coronary artery disease

Islam

2014

Anadolu Kardiyol Derg

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ALMANAC series 219Coronary heart disease in decline Epidemiological data from Europe, the USA and elsewhere in the developed world show a steep decline in coronary heart disease (CHD) mortality during the last 40 years (1). Concern about levelling of mortality rates in younger adults (2) has been somewhat alleviated by data from The Netherlands showing that in men aged <55 years, rates of decline have again accelerated, increasing from only 16% in 1993-1999 to 46% in 1999-2007 (3). A similar pattern was observed in young women with rates of decline of 5% and 38% during the same time periods. This is encouraging, particularly in the context of data from Denmark and the UK showing declining mortality and also a sharp fall in standardised incidence rates for acute myocardial infarction indicating that coronary prevention, as well as acute treatments, has contributed to recent mortality trends (4, 5). Meanwhile an Australian study reminds us that myocardial infarction is but one of several manifestations of cardiovascular disease by reporting that decreasing incidence and recurrence rates for hospitalised CHD from 2000 to 2007 have also been seen for cerebrovascular and peripheral arterial disease (6).However, the epidemiological news is not all good, and data from the UK show that the pernicious relationship between socioeconomic status (SES) and CHD has shown no tendency to go away in recent years, the gradients between top and bottom SES quintile groups for hospital admissions remaining essentially unchanged across the age range (7). Whether this has contributed to the almost 3-fold risk of myocardial infarction associated with stillbirth and 9-fold risk associated with recurrent miscarriage in a recent German study is unclear because the investigators made no adjustment for SES (8). Nor is it clear if SES has contributed to the persistent ethnic differences in both US and UK studies of CHD mortality although other factors appear also to be important. Thus, African-American men have greater exposure to CHD risk factors than Caucasians and, when adjustment is made for this, their susceptibility to CHD is no greater, although mortality rates are twice as high (9). For African-American women, incidence and mortality rates are higher than their Caucasian counter-parts. These findings suggesting that exposure to risk factors contributes to ethnic differences in the incidence of CHD are to some extent reflected in a recent report from the Health Survey for England in which 13 293 Caucasian and 2120 S Asians consented to mortality followup (10). Physical inactivity increased susceptibility to disease and not by increased case-fatality rates (11). Diagnosis of stable coronary artery diseaseThe recent AHA/ACC guideline update (12) emphasised the importance of individualising the diagnostic workup based on the estimated probability of coronary artery disease. In this respect, it mirrored an earlier National Institute of Clinical Excellence (NICE) guideline on chest pain diagnosis (13), but there were important differences ...

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Combination of carotid intima-media thickness and plaque for better predicting risk of ischaemic cardiovascular events

Abstract: The TBS could significantly improve the prediction of ICVD risk and should be used in clinical practice and future studies.

Cited by 60 publications

References 31 publications

Increased Carotid Intima-Media Thickness and Plasma Homocysteine Levels Predict Cardiovascular and All-Cause Death: A Population-Based Cohort Study

Increased Carotid Intima-Media Thickness and Plasma Homocysteine Levels Predict Cardiovascular and All-Cause Death: A Population-Based Cohort Study

Almanac 2012: cardiovascular risk scores. The journals present selected research that has driven recent advances in clinical cardiology

Almanac 2013-stable coronary artery disease

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