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The Clinical Significance of Separate Measurements of Carotid Arterial Wall to Assess the Risk Factor for Atherosclerosis

  • Kim, Ji-Hoon (Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Youn, Ho-Joong (Division of Cardiology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea) ;
  • Kim, Gee-Hee (Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Moon, Keon-Woong (Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Yoo, Ki-Dong (Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Chul-Min (Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea)
  • Received : 2015.11.04
  • Accepted : 2016.02.01
  • Published : 2016.03.27

Abstract

Background: Carotid intima-media thickness (CIMT) is associated with several risk factors for atherosclerosis and has been consistently linked to cardiovascular and cerebrovascular disease. The clinical significance of separate measurements of CIMT, which is the sum of the intima (IT) and media thickness (MT), to use as an assessment of risk for atherosclerosis has not yet been fully established. Methods: Among 3377 patients who underwent B-mode ultrasound of carotid arteries and coronary angiography in the Medical Department of St. Mary's Hospital from September 2003 to March 2009, 1146 subjects (M:F = 616:530; mean age, $57.7{\pm}12.1years$) who were diagnosed with normal coronary arteries were enrolled in this study. IT, MT, and CIMT of the enrolled patients were manually measured using high-frequency ultrasonography (15 MHz linear array transducer). Results: In multivariate logistic regression analysis, age (${\beta}=0.063$, p < 0.0001), body mass index (BMI) (${\beta}=0.028$, p = 0.018), and hypertension (HTN) (${\beta}=0.046$, p = 0.0002) were associated with MT ($R^2=0.256$) and the IT/MT ratio ($R^2=0.209$). Age (${\beta}=0.065$, p < 0.0001), BMI (${\beta}=0.025$, p = 0.038), hemoglobin A1c (${\beta}=0.045$, p = 0.045), and HTN (${\beta}=0.043$, p = 0.0006) correlated with mean CIMT ($R^2=0.230$). Age (${\beta}=-0.071$, p < 0.0001) and BMI (${\beta}=-0.046$, p = 0.002) were associated with the IT/MT ratio ($R^2=0.219$) on the left side. Age (${\beta}=0.093$, p < 0.0001) was related to MT ($R^2=0.265$) and mean CIMT ($R^2=0.243$) on the left side. Conclusion: We noted different atherosclerotic risk factors were related to measurements of the arterial wall in different ways. Therefore, separate measurements of CIMT might be a useful method to assess the risk for atherosclerosis.

Keywords

Acknowledgement

Supported by : Ministry of Health & Welfare

References

  1. Polak JF, Pencina MJ, Pencina KM, O'Donnell CJ, Wolf PA, D'Agostino RB Sr. Carotid-wall intima-media thickness and cardiovascular events. N Engl J Med 2011;365:213-21. https://doi.org/10.1056/NEJMoa1012592
  2. Finn AV, Kolodgie FD, Virmani R. Correlation between carotid intimal/medial thickness and atherosclerosis: a point of view from pathology. Arterioscler Thromb Vasc Biol 2010;30:177-81. https://doi.org/10.1161/ATVBAHA.108.173609
  3. Nguyen-Thanh HT, Benzaquen BS. Screening for subclinical coronary artery disease measuring carotid intima media thickness. Am J Cardiol 2009;104:1383-8. https://doi.org/10.1016/j.amjcard.2009.07.005
  4. Choi YS, Youn HJ, Youn JS, Park CS, Oh YS, Chung WS. Measurement of the intimal thickness of the carotid artery: comparison between 40 MHz ultrasound and histology in rats. Ultrasound Med Biol 2009;35:962-6. https://doi.org/10.1016/j.ultrasmedbio.2008.12.004
  5. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986;74:1399-406. https://doi.org/10.1161/01.CIR.74.6.1399
  6. Johnson HM, Douglas PS, Srinivasan SR, Bond MG, Tang R, Li S, Chen W, Berenson GS, Stein JH. Predictors of carotid intima-media thickness progression in young adults: the Bogalusa Heart Study. Stroke 2007;38:900-5. https://doi.org/10.1161/01.STR.0000258003.31194.0a
  7. Koskinen J, Kahonen M, Viikari JS, Taittonen L, Laitinen T, Ronnemaa T, Lehtimaki T, Hutri-Kahonen N, Pietikainen M, Jokinen E, Helenius H, Mattsson N, Raitakari OT, Juonala M. Conventional cardiovascular risk factors and metabolic syndrome in predicting carotid intima-media thickness progression in young adults: the cardiovascular risk in young Finns study. Circulation 2009;120:229-36. https://doi.org/10.1161/CIRCULATIONAHA.108.845065
  8. Tzou WS, Douglas PS, Srinivasan SR, Bond MG, Tang R, Chen W, Berenson GS, Stein JH. Increased subclinical atherosclerosis in young adults with metabolic syndrome: the Bogalusa Heart Study. J Am Coll Cardiol 2005;46:457-63. https://doi.org/10.1016/j.jacc.2005.04.046
  9. Mattsson N, Ronnemaa T, Juonala M, Viikari JS, Jokinen E, Hutri-Kahonen N, Kahonen M, Laitinen T, Raitakari OT. Arterial structure and function in young adults with the metabolic syndrome: the Cardiovascular Risk in Young Finns Study. Eur Heart J 2008;29:784-91. https://doi.org/10.1093/eurheartj/ehm576
  10. Bae JH, Kim WS, Rihal CS, Lerman A. Individual measurement and significance of carotid intima, media, and intima-media thickness by B-mode ultrasonographic image processing. Arterioscler Thromb Vasc Biol 2006;26:2380-5. https://doi.org/10.1161/01.ATV.0000240420.36229.f9
  11. Semba I, Funakoshi K, Kitano M. Histomorphometric analysis of age changes in the human inferior alveolar artery. Arch Oral Biol 2001;46:13-21. https://doi.org/10.1016/S0003-9969(00)00100-X
  12. Won HK, Kim WS, Kim KY, Hyun DW, Kwon TG, Bae JH. Increased carotid intima-media thickness in hypertensive patients is caused by increased medial thickness. Korean J Med 2008;75:179-85.
  13. Gussenhoven EJ, Frietman PA, The SH, van Suylen RJ, van Egmond FC, Lancee CT, van Urk H, Roelandt JR, Stijnen T, Bom N. Assessment of medial thinning in atherosclerosis by intravascular ultrasound. Am J Cardiol 1991;68:1625-32. https://doi.org/10.1016/0002-9149(91)90320-K
  14. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS; American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008;21:93-111; quiz 189-90. https://doi.org/10.1016/j.echo.2007.11.011
  15. Iannuzzi A, De Michele M, Bond MG, Sacchetti L, Fortunato G, Salvatore F, Mattiello A, Panico S, Rubba P. Carotid artery remodeling in middle-aged women with the metabolic syndrome (from the "Progetto ATENA" study). Am J Cardiol 2005;96:1162-5. https://doi.org/10.1016/j.amjcard.2005.06.048
  16. Kim G, Kim JH, Moon KW, Yoo KD, Ihm SH, Youn HJ, Kim CM. The clinical usefulness of central hemodynamics to evaluate diastolic dysfunction in subjects without hypertension. Clin Interv Aging 2014;9:527-33.
  17. Okumura K, Yasue H, Horio Y, Takaoka K, Matsuyama K, Kugiyama K, Fujii H, Morikami Y. Multivessel coronary spasm in patients with variant angina: a study with intracoronary injection of acetylcholine. Circulation 1988;77:535-42. https://doi.org/10.1161/01.CIR.77.3.535
  18. McMahan CA, Gidding SS, Viikari JS, Juonala M, Kahonen M, Hutri-Kahonen N, Jokinen E, Taittonen L, Pietikainen M, McGill HC Jr, Raitakari OT. Association of Pathobiologic Determinants of Atherosclerosis in Youth risk score and 15-year change in risk score with carotid artery intima-media thickness in young adults (from the Cardiovascular Risk in Young Finns Study). Am J Cardiol 2007;100:1124-9. https://doi.org/10.1016/j.amjcard.2007.05.035
  19. Nakashima Y, Chen YX, Kinukawa N, Sueishi K. Distributions of diffuse intimal thickening in human arteries: preferential expression in atherosclerosis-prone arteries from an early age. Virchows Arch 2002;441:279-88. https://doi.org/10.1007/s00428-002-0605-1
  20. Roman MJ, Naqvi TZ, Gardin JM, Gerhard-Herman M, Jaff M, Mohler E; American Society of Echocardiography; Society of Vascular Medicine and Biology. Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. J Am Soc Echocardiogr 2006;19:943-54. https://doi.org/10.1016/j.echo.2006.04.020
  21. Rodriguez-Macias KA, Lind L, Naessen T. Thicker carotid intima layer and thinner media layer in subjects with cardiovascular diseases. An investigation using noninvasive high-frequency ultrasound. Atherosclerosis 2006;189:393-400. https://doi.org/10.1016/j.atherosclerosis.2006.02.020
  22. Urbina EM, Srinivasan SR, Tang R, Bond MG, Kieltyka L, Berenson GS; Bogalusa Heart Study. Impact of multiple coronary risk factors on the intima-media thickness of different segments of carotid artery in healthy young adults (The Bogalusa Heart Study). Am J Cardiol 2002;90:953-8. https://doi.org/10.1016/S0002-9149(02)02660-7