Published online before print March 1, 2004, doi: 10.1161/01.CIR.0000120708.59903.1B
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(Circulation. 2004;109:1089-1094.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Predictive Value of Noninvasive Measures of Atherosclerosis for Incident Myocardial Infarction
The Rotterdam Study
From the Department of Epidemiology and Biostatistics, Erasmus MC, University Medical Center, Rotterdam (all authors), and Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht (M.L.B.), the Netherlands.
Correspondence to Dr Jacqueline C.M. Witteman, Department of Epidemiology and Biostatistics, Erasmus Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail j.witteman{at}erasmusmc.nl
Received February 24, 2003; de novo received October 16, 2003; accepted December 2, 2003.
Background— Several noninvasive methods are available to investigate the severity of extracoronary atherosclerotic disease. No population-based study has yet examined whether differences exist between these measures with regard to their predictive value for myocardial infarction (MI) or whether a given measure of atherosclerosis has predictive value independently of the other measures.
Methods and Results— At the baseline (1990–1993) examination of the Rotterdam Study, a population-based cohort study among subjects age 
55 years, carotid plaques and intima-media thickness (IMT) were measured by ultrasound, abdominal aortic atherosclerosis by x-ray, and lower-extremity atherosclerosis by computation of the ankle-arm index. In the present study, 6389 subjects were included; 258 cases of incident MI occurred before January 1, 2000. All 4 measures of atherosclerosis were good predictors of MI independently of traditional cardiovascular risk factors. Hazard ratios were equally high for carotid plaques (1.83 [1.27 to 2.62], severe versus no atherosclerosis), carotid IMT (1.95 [1.19 to 3.19]), and aortic atherosclerosis (1.94 [1.30 to 2.90]) and slightly lower for lower-extremity atherosclerosis (1.59 [1.05 to 2.39]), although differences were small. The hazard ratio for MI for subjects with severe atherosclerosis according to a composite atherosclerosis score was 2.77 (1.70 to 4.52) compared with subjects with no atherosclerosis. The predictive value of MI for a given measure of atherosclerosis was independent of the other atherosclerosis measures.
Conclusions— Noninvasive measures of extracoronary atherosclerosis are strong predictors of MI. The relatively crude measures directly assessing plaques in the carotid artery and abdominal aorta predict MI equally well as the more precisely measured carotid IMT.
Key Words: atherosclerosis • coronary disease • epidemiology
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