Elsevier

Atherosclerosis

Volume 219, Issue 2, December 2011, Pages 917-924
Atherosclerosis

Carotid intima-media thickness in plaque-free site, carotid plaques and coronary heart disease risk prediction in older adults. The Three-City Study

https://doi.org/10.1016/j.atherosclerosis.2011.09.024Get rights and content

Abstract

Objectives

We sought to address the respective association between carotid intima-media thickness (IMT) in plaque-free sites and plaques with coronary heart disease (CHD) and their usefulness for CHD risk prediction in the Three-City Study.

Methods

At baseline, 5895 CHD-free adults aged 65–85 years underwent a bilateral ultrasound examination of carotid arteries. Mean IMT was measured in the far wall of the right and left common carotid arteries (CCA) at plaque-free site while the presence of focal plaques was assessed in the near and the far walls of the CCAs, the bifurcations and the origin of the internal carotid arteries.

Results

After a median follow-up of 5.4 years, 223 subjects had a first ever CHD event. In multivariate analysis, carotid plaques were independent predictors of CHD (Hazard ratio (HR)plaques at 1 site = 1.5; 95% confidence interval (CI) = 1.0–2.2; HRplaques at ≥2 sites = 2.2; 95% CI = 1.6–3.1; pfor trend < 0.001), contrary to mean CCA-IMT (HRfifth vs. first quintile = 0.8; 95% CI = 0.5–1.2; pfor trend < 0.48). Adding carotid plaques to conventional risk factors significantly improved CHD risk prediction as measured by the area under the ROC curve (from 0.728 to 0.745; p = 0.04), the Harrell's c (from 0.748 to 0.762; p < 0.001), and the integrated discrimination improvement (IDI = 0.007; p = 0.002)/net reclassification improvement (NRI = 13.7%; p < 0.001) indices.

Conclusion

Carotid plaques, but not CCA-IMT measured at a plaque-free site, were independent predictors of CHD and improved CHD risk prediction in older adults.

Section snippets

Population

The Three-City Study is a French multisite prospective study investigating the determinants of coronary heart disease, stroke and dementia. Details of the protocol have been described previously. [21] Briefly, 9294 community dwellers 65 years or older were selected between March 1999 and March 2001 from the electoral rolls of 3 French cities (Bordeaux, South-West, n = 2104; Dijon, North-East, n = 4931; Montpellier, South, n = 2259). The study protocol was approved by the Ethical Committee of the

Baseline characteristics

The mean (SD) age was 73.3 (4.9) years and 37.1% were men. The mean (SD) CCA-IMT was 0.712 (0.120) mm and 44.4% had at least carotid plaques at one site. The mean levels of the risk factors were higher and the use of medications more frequent in those with carotid plaques and in those with higher CCA-IMT (Table 1A, Table 1B). The mean CCA-IMT increased with the number of sites with carotid plaques and vice versa.

Associations with incident CHD

After a median follow-up of 5.4 years, 223 subjects had a first ever CHD event.

Discussion

In this large prospective cohort of older adults, the risk of CHD over 6 years increased with ultrasound-detected carotid plaques but not with mean CCA-IMT measured at a site free of any discrete plaques. Furthermore, presence or absence of ultrasound-detected carotid plaques improved significantly CHD risk prediction beyond conventional risk factors.

Authors contributions

Conception and design, acquisition of data: Christophe Tzourio, Karen Ritchie and Pierre Ducimetière.

Analysis and interpretation of data, drafting of the manuscript: Matthieu Plichart.

Critical revision of the manuscript for important intellectual content: David S Celermajer, Mahmoud Zureik, Catherine Helmer, Xavier Jouven, Karen Ritchie, Christophe Tzourio, Pierre Ducimetière and Jean-Philippe Empana.

Drafting of the manuscript, supervision, had full access to all the data and takes

Conflict of interest disclosures

None

Acknowledgments

The Three-City Study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the Victor Segalen – Bordeaux II University, and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The 3C Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Conseils Régionaux of Aquitaine and

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