03118nas a2200373 4500008004100000022001400041245016800055210006900223260001300292300001600305490000700321520198600328653000902314653002802323653003502351653002102386653001602407653001102423653001102434653001402445653002502459653000902484653003102493653001702524653003202541653001102573653001802584100002202602700002002624700002102644700002302665700002002688856003602708 2014 eng d a1097-679500aWhat do carotid intima-media thickness and plaque add to the prediction of stroke and cardiovascular disease risk in older adults? The cardiovascular health study.0 aWhat do carotid intimamedia thickness and plaque add to the pred c2014 Sep a998-1005.e20 v273 a

BACKGROUND: The aim of this study was to evaluate whether the addition of ultrasound carotid intima-media thickness (CIMT) measurements and risk categories of plaque help predict incident stroke and cardiovascular disease (CVD) in older adults.

METHODS: Carotid ultrasound studies were recorded in the multicenter Cardiovascular Health Study. CVD was defined as coronary heart disease plus heart failure plus stroke. Ten-year risk prediction Cox proportional-hazards models for stroke and CVD were calculated using Cardiovascular Health Study-specific coefficients for Framingham risk score factors. Categories of CIMT and CIMT plus plaque were added to Framingham risk score prediction models, and categorical net reclassification improvement (NRI) and Harrell's c-statistic were calculated.

RESULTS: In 4,384 Cardiovascular Health Study participants (61% women, 14% black; mean baseline age, 72 ± 5 years) without CVD at baseline, higher CIMT category and the presence of plaque were both associated with higher incidence rates for stroke and CVD. The addition of CIMT improved the ability of Framingham risk score-type risk models to discriminate cases from noncases of incident stroke and CVD (NRI = 0.062, P = .015, and NRI = 0.027, P < .001, respectively), with no further improvement by adding plaque. For both outcomes, NRI was driven by down-classifying those without incident disease. Although the addition of plaque to CIMT did not result in a significant NRI for either outcome, it was significant among those without incident disease.

CONCLUSIONS: In older adults, the addition of CIMT modestly improves 10-year risk prediction for stroke and CVD beyond a traditional risk factor model, mainly by down-classifying risk in those without stroke or CVD; the addition of plaque to CIMT adds no statistical benefit in the overall cohort, although there is evidence of down-classification in those without events.

10aAged10aCardiovascular Diseases10aCarotid Intima-Media Thickness10aCarotid Stenosis10aComorbidity10aFemale10aHumans10aIncidence10aLongitudinal Studies10aMale10aReproducibility of Results10aRisk Factors10aSensitivity and Specificity10aStroke10aSurvival Rate1 aGardin, Julius, M1 aBartz, Traci, M1 aPolak, Joseph, F1 aO'Leary, Daniel, H1 aWong, Nathan, D uhttps://chs-nhlbi.org/node/6564