@article {1466, title = {Compensatory increase in common carotid artery diameter. Relation to blood pressure and artery intima-media thickness in older adults. Cardiovascular Health Study.}, journal = {Stroke}, volume = {27}, year = {1996}, month = {1996 Nov}, pages = {2012-5}, abstract = {

BACKGROUND AND PURPOSE: Common carotid artery (CCA) diameter is thought to increase as a consequence of hypertension and may increase as the thickness of the arterial wall increases. The purpose of this study was to determine CCA dimensions and correlate them with clinical features.

METHODS: We performed a cross-sectional, community-based study of adults 65 years of age and older, measuring inner and outer diameter of the CCA in vivo with carotid sonography. Findings were correlated against risk factors for atherosclerosis, CCA intima-media thickness (IMT), and echocardiographically determined left ventricular (LV) mass.

RESULTS: Independent variables showing strong positive associations with outer and inner CCA diameter included age, male sex, height, weight, and systolic blood pressure. As an independent variable, LV mass (r = .40 and r = .37, respectively; P < .00001) had a strong positive relation to inner and outer CCA diameters. The relationship between diameter and IMT was different. In a model that controlled for age, sex, and estimated LV mass, an increase of 1 mm in CCA IMT corresponded to a 1.9 mm increase in the outer diameter of the artery (P < .00001) but was not significantly related to the inner diameter (slope = +0.07 mm; P = .26).

CONCLUSIONS: Increase in the outer diameter of the CCA is associated with subject size, sex, age, echocardiographically estimated LV mass, and CCA IMT. Increases in internal diameter of the CCA have similar relationships but are not related to IMT. This supports the hypothesis that the human CCA dilates as the thickness of the artery wall increases.

}, keywords = {Aged, Blood Pressure, Carotid Artery, Common, Cross-Sectional Studies, Echocardiography, Female, Heart Ventricles, Humans, Hypertension, Male, Tunica Intima, Tunica Media}, issn = {0039-2499}, author = {Polak, J F and Kronmal, R A and Tell, G S and O{\textquoteright}Leary, D H and Savage, P J and Gardin, J M and Rutan, G H and Borhani, N O} } @article {1453, title = {Thickening of the carotid wall. A marker for atherosclerosis in the elderly? Cardiovascular Health Study Collaborative Research Group.}, journal = {Stroke}, volume = {27}, year = {1996}, month = {1996 Feb}, pages = {224-31}, abstract = {

BACKGROUND AND PURPOSE: We investigated the relationships between prevalent coronary heart disease (CHD), clinically manifest atherosclerotic disease (ASD), and major established risk factors for atherosclerosis and intima-media thickness (IMT) in the common carotid arteries (CCA) and internal carotid arteries (ICA) separately and in combination in older adults. We wished to determine whether a noninvasive measurement can serve as an indicator of clinically manifest atherosclerotic disease and to determine which of the two variables, CCA IMT or ICA IMT, is a better correlate.

METHODS: IMT of the CCA and ICA was measured with duplex ultrasound in 5117 of 5201 individuals enrolled in the Cardiovascular Health Study, a study of the risk factors and the natural history of cardiovascular disease in adults aged 65 years or more. Histories of CHD, peripheral arterial disease, and cerebrovascular disease were obtained during baseline examination. Risk factors included cholesterol levels, cigarette smoking, elevated blood pressure, diabetes, age, and sex. Relationships between risk factors and IMT were studied by multiple regression analysis and canonical variate analysis. Prediction of prevalent CHD and ASD by IMT measurements in CCAs and ICAs were made by logistic regression, adjusting for age and sex.

RESULTS: IMT measurements of the CCAs and ICAs were greater in persons with CHD and ASD than those without, even after controlling for sex (P < .001). IMT measurements in the ICA were greater than those in the CCA. Risk factors for ASD accounted for 17\% and 18\% of the variability in IMT in the CCA and ICA, respectively. These same risk factors accounted for 25\% of the variability of a composite measurement consisting of the sum of the ICA IMT and CCA IMT. The ability to predict CHD and ASD was greater for ICA IMT (odds ratio [confidence interval]: 1.36 [1.31 to 1.41] and 1.35 [1.25 to 1.44], respectively) than for CCA IMT (1.09 [1.05 to 1.13] and 1.17 [1.09 to 1.25]).

CONCLUSIONS: Whereas CCA IMT is associated with major risk factors for atherosclerosis and existing CHD and ASD in older adults, this association is not as strong as that for ICA IMT. The combination of these measures relates more strongly to existing CHD and ASD and cerebrovascular disease risk factors than either taken alone.

}, keywords = {Adult, Aged, Arteriosclerosis, Blood Pressure, Carotid Artery, Common, Carotid Artery, Internal, Cholesterol, HDL, Cholesterol, LDL, Cohort Studies, Coronary Disease, Diabetes Mellitus, Diabetic Angiopathies, Electrocardiography, Female, Humans, Male, Medical History Taking, Physical Examination, Prospective Studies, Regression Analysis, Risk Factors, Sex Characteristics, Smoking, Tunica Intima, Tunica Media, Ultrasonography}, issn = {0039-2499}, author = {O{\textquoteright}Leary, D H and Polak, J F and Kronmal, R A and Savage, P J and Borhani, N O and Kittner, S J and Tracy, R and Gardin, J M and Price, T R and Furberg, C D} } @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} } @article {664, title = {Relation of hemodynamics and risk factors to ventricular-vascular interactions in the elderly: the Cardiovascular Health Study.}, journal = {J Hypertens}, volume = {19}, year = {2001}, month = {2001 Oct}, pages = {1893-903}, abstract = {

OBJECTIVE: To investigate the interaction between left ventricular (LV) geometry, carotid structure and arterial compliance in relation to hemodynamic stimuli and risk factors (plasma cholesterol, body mass index, insulin resistance, smoking habit, age, sex and race).

DESIGN: Cross-sectional.

METHODS: Echocardiography and carotid ultrasound were performed in 2375 elderly subjects without signs or history of prevalent cardiovascular disease, diabetes or renal disease (795 men; 298 non-whites; 1215 hypertensive), from the cohort of the Cardiovascular Health Study. Arterial compliance was estimated by the prognostically validated ratio of stroke volume to pulse pressure (SV/PP) as the percent deviation (Delta\%) from the value predicted by individual age, heart rate and body weight.

RESULTS: Intima-medial thickness (IMT) was higher in the presence of LV hypertrophy (LVH) in normotensive and hypertensive subjects and was greatest in the presence of concentric LVH. Maximum carotid lumen diameter (CLD) was also higher in the presence of LVH (and was greatest with eccentric LVH, in association with relatively high values for stroke volume). After adjusting for blood pressure, maximum carotid lumen diameter was directly correlated with stroke volume, and IMT to LV mass (all P < 0.001). Similarly, IMT was also related to maximum carotid lumen diameter, independently of prevalent risk factors (P < 0.001). SV/PP-Delta\% was reduced in both groups with concentric LV remodeling (both P < 0.0001) or concentric LVH (both P < 0.05). Adjusting for risk factors did not affect these associations in normotensives, but made them insignificant in hypertensives. In normotensives, IMT was inversely related to SV/PP-Delta\% (P < 0.001), independently of risk factors, whereas no significant relation was found in hypertensives.

CONCLUSIONS: The magnitudes of carotid intima-medial thickness and lumen diameter parallel levels of LV mass and geometry, and are directly related to stroke volume and arterial stiffness; this interaction is most evident in the presence of normal blood pressure, whereas it is affected by other cardiovascular risk factors when arterial hypertension is present.

}, keywords = {Aged, Aged, 80 and over, Blood Pressure, Carotid Arteries, Compliance, Cross-Sectional Studies, Echocardiography, Female, Hemodynamics, Humans, Hypertension, Hypertrophy, Left Ventricular, Male, Reference Values, Risk Factors, Stroke Volume, Tunica Intima, Tunica Media, Ventricular Function, Left}, issn = {0263-6352}, doi = {10.1097/00004872-200110000-00026}, author = {de Simone, G and McClelland, R and Gottdiener, J S and Celentano, A and Kronmal, R A and Gardin, J M} } @article {704, title = {Relationship between coronary artery calcification and other measures of subclinical cardiovascular disease in older adults.}, journal = {Arterioscler Thromb Vasc Biol}, volume = {22}, year = {2002}, month = {2002 Oct 01}, pages = {1674-9}, abstract = {

BACKGROUND: In the Cardiovascular Health Study, subclinical cardiovascular disease (CVD) predicted CVD events in older adults. The extent to which this measure or its components reflect calcified coronary disease is unknown.

METHODS AND RESULTS: Coronary artery calcium (CAC) was assessed with electron beam tomography in 414 participants without clinical CVD and examined using cut points (CAC> or =400 and CAC> or =800) and the log(CAC); 274 had subclinical CVD by ankle-arm index, ECG, or carotid ultrasound. Cut points for subclinical disease as previously defined in the Cardiovascular Health Study were examined as well as continuous measures to produce receiver operating characteristic curve curves. A low ankle-arm index was highly specific for a high CAC score. The internal carotid artery intima-media thickness was most strongly correlated with CAC (r=0.30) and was significantly related to both CAC cut points and to the log(CAC) score independently of all other measures.

CONCLUSIONS: In these community-dwelling older adults without clinical CVD, internal carotid artery intima-media thickness was most closely related to CAC. However, 17.5\% of those with a CAC> or =400 would be missed in the ascertainment of subclinical atherosclerosis using the previously published composite of subclinical atherosclerosis. Prospective follow-up will determine whether the CAC score improves prediction of CVD events over other noninvasive measures.

}, keywords = {Aged, Aged, 80 and over, Calcinosis, Cardiovascular Diseases, Carotid Stenosis, Cohort Studies, Coronary Artery Disease, Demography, Female, Humans, Male, Prevalence, Risk Factors, Sensitivity and Specificity, Sex Factors, Tomography, X-Ray Computed, Tunica Intima, Tunica Media}, issn = {1524-4636}, doi = {10.1161/01.atv.0000033540.89672.24}, author = {Newman, Anne B and Naydeck, Barbara L and Sutton-Tyrrell, Kim and Edmundowicz, Daniel and O{\textquoteright}Leary, Daniel and Kronmal, Richard and Burke, Gregory L and Kuller, Lewis H} }