@article {1082, title = {Use of sonography to evaluate carotid atherosclerosis in the elderly. The Cardiovascular Health Study. CHS Collaborative Research Group.}, journal = {Stroke}, volume = {22}, year = {1991}, month = {1991 Sep}, pages = {1155-63}, abstract = {

Carotid sonography is being performed on more than 5,000 participants in the Cardiovascular Health Study, a prospective, multicenter study of cardiovascular disease in men and women aged 65 years and older. The sonographic methods used to examine and measure the extracranial carotid arteries are described. Initial validation studies were performed on 61 subjects with a mean age of 68.6 years. Analysis of within- and between-sonographer differences and between-reader differences were performed for selected variables. In general, the mean absolute differences for within- and between-sonographer comparisons were small, with even less variability between readers. Variability was less for the common carotid artery than for the internal carotid artery. These data suggest that carotid sonography is a reliable and reproducible method for use in the study of carotid atherosclerosis in population studies.

}, keywords = {Age Factors, Aged, Arteriosclerosis, Carotid Arteries, Carotid Artery Diseases, Carotid Artery, Internal, Female, Humans, Image Interpretation, Computer-Assisted, Image Processing, Computer-Assisted, Male, Prospective Studies, Ultrasonography}, issn = {0039-2499}, doi = {10.1161/01.str.22.9.1155}, author = {O{\textquoteright}Leary, D H and Polak, J F and Wolfson, S K and Bond, M G and Bommer, W and Sheth, S and Psaty, B M and Sharrett, A R and Manolio, T A} } @article {1486, title = {Does the association of risk factors and atherosclerosis change with age? An analysis of the combined ARIC and CHS cohorts. The Atherosclerosis Risk in Communities (ARIC) and Cardiovascular Health Study (CHS) investigators.}, journal = {Stroke}, volume = {28}, year = {1997}, month = {1997 Sep}, pages = {1693-701}, abstract = {

INTRODUCTION: A decrease in the estimated relative risk of cerebrovascular and cardiovascular diseases associated with known disease risk factors has been observed among elderly cohorts, perhaps suggesting that continued risk factor management in the elderly may not be as efficacious as with younger age groups. In this paper, the differential magnitude of the association of risk factors with atherosclerosis across the age spectrum from 45 years to older than 75 years is presented.

METHODS: Subclinical atherosclerosis as measured by carotid ultrasonography and risk factor prevalence were assessed using similar methods among participants aged 45 to 64 years in the Atherosclerosis Risk in Communities (ARIC) study and among participants 65 years and older in the Cardiovascular Health Study (CHS). Pooling these two cohorts provided data on the relationship of risk factors and atherosclerosis on nearly 19,000 participants over a broad age range. Regression analyses were used to assess the consistency of the magnitude of the association of risk factors with atherosclerosis across the age spectrum separately for black and white participants in cross-sectional analyses.

RESULTS: As expected, each of the risk factors was globally (across all ages) associated with increased atherosclerosis. However, the magnitude of the association did not differ across the age spectrum for hypertension, low density lipoprotein cholesterol (LDL-c), fibrinogen, or body mass index (BMI). For whites, there was a significantly greater impact of smoking and HDL-C among older age strata but a smaller impact of diabetes. For black women, the impact of HDL-C decreased among the older age strata.

CONCLUSIONS: These data suggest that most risk factors continue to be associated with increased atherosclerosis at older ages, possibly suggesting a continued value in investigation of strategies to reduce atherosclerosis by controlling risk factors at older ages.

}, keywords = {African Americans, African Continental Ancestry Group, Aged, Aging, Arteriosclerosis, Body Mass Index, Cardiovascular Physiological Phenomena, Cardiovascular System, Carotid Arteries, Cholesterol, HDL, Cholesterol, LDL, Cohort Studies, European Continental Ancestry Group, Female, Fibrinogen, Health Status, Humans, Hypertension, Male, Middle Aged, Regression Analysis, Risk Factors, Sex Factors, Smoking, Tunica Intima, Tunica Media, Ultrasonography}, issn = {0039-2499}, author = {Howard, G and Manolio, T A and Burke, G L and Wolfson, S K and O{\textquoteright}Leary, D H} } @article {1520, title = {Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group.}, journal = {N Engl J Med}, volume = {340}, year = {1999}, month = {1999 Jan 07}, pages = {14-22}, abstract = {

BACKGROUND: The combined thickness of the intima and media of the carotid artery is associated with the prevalence of cardiovascular disease. We studied the associations between the thickness of the carotid-artery intima and media and the incidence of new myocardial infarction or stroke in persons without clinical cardiovascular disease.

METHODS: Noninvasive measurements of the intima and media of the common and internal carotid artery were made with high-resolution ultrasonography in 5858 subjects 65 years of age or older. Cardiovascular events (new myocardial infarction or stroke) served as outcome variables in subjects without clinical cardiovascular disease (4476 subjects) over a median follow-up period of 6.2 years.

RESULTS: The incidence of cardiovascular events correlated with measurements of carotid-artery intima-media thickness. The relative risk of myocardial infarction or stroke increased with intima-media thickness (P<0.001). The relative risk of myocardial infarction or stroke (adjusted for age and sex) for the quintile with the highest thickness as compared with the lowest quintile was 3.87 (95 percent confidence interval, 2.72 to 5.51). The association between cardiovascular events and intima-media thickness remained significant after adjustment for traditional risk factors, showing increasing risks for each quintile of combined intima-media thickness, from the second quintile (relative risk, 1.54; 95 percent confidence interval, 1.04 to 2.28), to the third (relative risk, 1.84; 95 percent confidence interval, 1.26 to 2.67), fourth (relative risk, 2.01; 95 percent confidence interval, 1.38 to 2.91), and fifth (relative risk, 3.15; 95 percent confidence interval, 2.19 to 4.52). The results of separate analyses of myocardial infarction and stroke paralleled those for the combined end point.

CONCLUSIONS: Increases in the thickness of the intima and media of the carotid artery, as measured noninvasively by ultrasonography, are directly associated with an increased risk of myocardial infarction and stroke in older adults without a history of cardiovascular disease.

}, keywords = {Aged, Carotid Arteries, Cerebrovascular Disorders, Disease-Free Survival, Female, Humans, Incidence, Male, Myocardial Infarction, Proportional Hazards Models, Prospective Studies, Risk Factors, Tunica Intima, Tunica Media, Ultrasonography}, issn = {0028-4793}, doi = {10.1056/NEJM199901073400103}, author = {O{\textquoteright}Leary, D H and Polak, J F and Kronmal, R A and Manolio, T A and Burke, G L and Wolfson, S K} }