Ultrasound Morphology Classification of the Arterial Wall and Cardiovascular Events in a 6-Year Follow-up Study

Abstract

A 6-year follow-up based on an arterial morphology classification defined with an ultrasound assessment of carotid and femoral artery bifurcations was conducted on 2322 asymptomatic subjects. Four morphology classes were considered. When 2000 subjects (86% of total subjects; 1124 males, 876 females) completed a 6-year follow-up, the study was terminated. At 6 years, no cardiovascular events were observed in subjects who were in class I (80.05% of the population sample) at inclusion; there were 69 events in classes II, III, and IV (19.95% of the population; incidence, 17.3%); 59 events, including the five deaths, occurred in classes III and IV (10.85% of the population), producing an event incidence of 27.2%. The increased event rate in classes II, III, and IV was significant (log-rank test; P < .05, P < .025, and P < .025, respectively). Thus, the arterial morphology classification identified 19.95% of the population (subjects in classes II, III, and IV) in which all events occurred. There was a higher (P < .05) rate of progression of altered arterial morphology in 6 years in classes III (26.5% of subjects progressed) and IV (41.9% progressed) than in classes I and II. The total number of cigarette-years was higher (P < .05) in classes II, III, and IV than in class I. In conclusion, the ultrasound-based arterial classification was useful in selecting from the population sample 80.05% of subjects (class I) who remained event-free for 6 years. All events occurred in class II, III, and IV subjects (19.95%), and all five deaths (0.25% of the population) occurred in classes III and IV (10.85% of the sample).

Predictive Value of Noninvasive Measures of Atherosclerosis for Incident Myocardial Infarction

“…[5][6][7][8][9][10][11][12]20 Compared with carotid IMT and the AAI, the presence and severity of carotid plaques or aortic atherosclerosis are less frequently studied in relation to cardiovascular disease. Importantly, the present study shows that the hazard ratios for MI for these measures, which are based on the relatively crude but direct assessment of the presence of atherosclerotic plaques, were as high as those for carotid IMT, a measure that requires very precise measurements.…”

Carotid Intimal-Medial Thickness and Stiffness Are Not Affected by Hypercholesterolemia in Uncomplicated Essential Hypertension

“…Therefore, early atherosclerotic lesions involving only the intimal layer may cause only small increases in the composite wall thickness measured by vascular ultrasonography that might be confused with medial hypertrophy in the presence of hypertension. Although this could be a major limitation of ultrasonographic studies of preclinical atherosclerosis, the consistent ability of increased IMT to predict cardiovascular events in multiple populations [11][12][13][14][15] suggests that the different processes that increase overall carotid wall thickness are all prognostically adverse. Furthermore, since the atherosclerotic process typically involves the arterial wall in a focal fashion, whereas hypertension induces diffuse thickening of the intimal-medial complex, 46 ultrasonographic identification of focal intimal-medial thickening can be considered a reliable indicator of atherosclerosis per se.…”

“…Previous reports have indicated that carotid intimal-medial thickening is associated with coronary artery disease 9,10 and cardiovascular morbidity and mortality. [11][12][13][14][15] Moreover, carotid intimalmedial thickening has been described in association with hypertension 16,17 and hypercholesterolemia. 18,19 Studies of hypercholesterolemia have, however, included subjects with mild hypertension and/or symptomatic cardiovascular disease, and thus, they could not assess the independent contributions of uncomplicated hypertension and hypercholesterolemia to intimal-medial thickening.…”

Normative values of carotid artery intima-media thickness in healthy Korean adults and estimation of macrovascular diseases relative risk using this data in type 2 diabetes patients

“…Thus, it may be difficult to use the IMT as an exact normative value. In addition, we cannot demonstrate the prevalence of carotid artery plaque formation, which is a strong predictor of cardiovascular diseases [19,29,30].…”