From the Laboratory of Clinical Investigation (Y.M., J.M.) and Laboratory
of Cardiovascular Science (E.G.L., J.L.F.), Gerontology Research Center,
National Institute on Aging, National Institutes of Health, Baltimore, Md;
Department of Neurology, Johns Hopkins Bayview Medical Center (C.J.E.,
M.K.K.); and Division of Cardiology, Johns Hopkins University School of
Medicine (L.C.B.), Baltimore, Md.
Correspondence to E. Jeffrey Metter, MD, Laboratory of Clinical Investigation, Gerontology Research Center-Box 06, 5600 Nathan Shock Dr, Baltimore, MD 21224. E-mail jeffrey{at}vax.grc.nia.nih.gov
Background—Previous studies have
shown an association between symptomatic coronary
artery disease (CAD) and increased intimal-medial thickness of the
common carotid artery (CCA IMT), a purported index of
atherosclerosis. This study determines whether CCA IMT
is increased in asymptomatic older subjects with an
ischemic ST-segment response to treadmill exercise.
Methods and Results—CCA IMT was measured by B-mode ultrasound in
community-dwelling volunteers from the Baltimore Longitudinal Study of
Aging, including 397 healthy subjects (age, 58.5±15.8 years) with
normal ECG responses to maximum treadmill exercise, 72
asymptomatic subjects (age, 66.1±13.4 years) with
exercise-induced horizontal or downsloping ST-segment depression
Conclusions—CCA IMT is increased in older subjects with
asymptomatic myocardial ischemia as evidenced by
exercise ECG alone or in combination with thallium scan. Carotid
ultrasound may help to identify asymptomatic individuals
with CAD.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Increased Carotid Artery Intimal-Medial Thickness in Asymptomatic Older Subjects With Exercise-Induced Myocardial Ischemia
1 mm, and 38 subjects (age, 77.4±7.8 years) with clinically
manifest CAD as diagnosed by medical history and resting ECG.
Forty-three subjects with abnormal exercise ECGs also underwent
exercise thallium scintigraphy. Exercise-induced ST-segment
depression was associated with increased IMT (P<0.0001)
independent of age and manifest CAD. After adjustment for age, IMT
values progressively increased from healthy subjects to
asymptomatic subjects with positive exercise ECG alone to
those with concordant positive ECG and thallium scintigraphic findings
who had virtually identical IMT to subjects with manifest CAD. Each
0.1-mm increase in IMT was associated with a 1.91-fold (95% CI, 1.46
to 2.50; P<0.0001) increased risk for concordant
positive exercise tests or manifest CAD, independent of other
significant predictors of CAD.
Key Words: coronary disease • carotid arteries • ultrasonics • exercise • risk factors
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