(Circulation. 1997;96:1432-1437.)
© 1997 American Heart Association, Inc.
Articles |
Common Carotid Intima-Media Thickness and Risk of Stroke and Myocardial Infarction
The Rotterdam Study
From the Department of Epidemiology and Biostatistics (M.L.B., A.W.H., A.H., D.E.G.) and Department of General Practice (A.W.H.), Erasmus University Medical School, Rotterdam, Netherlands; Julius Center of Patient Oriented Research (M.L.B., A.W.H., D.E.G.), Utrecht University, Netherlands; and Department of Neurology (P.J.K.), University Hospital Rotterdam, The Netherlands.
Correspondence to Prof D.E. Grobbee, MD, PhD, Department of Epidemiology and Biostatistics, Erasmus University Medical School, PO Box 1738, 3000 DR Rotterdam, Netherlands. E-mail D.E.Grobbee{at}med.ruu.nl
Background Noninvasive assessment of intima-media thickness (IMT) is widely used in observational studies and trials as an intermediate or proxy end point for cardiovascular disease. However, data showing that IMT predicts cardiovascular disease are limited. We studied whether common carotid IMT is related to future stroke and myocardial infarction.
Methods and Results We used a nested case-control approach
among 7983 subjects aged 
55 years participating in the Rotterdam
Study. At baseline (March 1990 through July 1993), ultrasound images of
the common carotid artery were stored on videotape. Determination of
incident myocardial infarction and stroke was predominantly based on
hospital discharge records. Analysis (logistic regression)
was based on 98 myocardial infarctions and 95 strokes that were
registered before December 31, 1994. IMT was measured from videotape
for all case subjects and a sample of 1373 subjects who remained free
from myocardial infarction and stroke during follow-up. The mean
duration of follow-up was 2.7 years. Results were adjusted for age and
sex. Stroke risk increased gradually with increasing IMT. The odds
ratio for stroke per standard deviation increase (0.163 mm) was
1.41 (95% CI, 1.25 to 1.82). For myocardial infarction, an odds ratio
of 1.43 (95% CI, 1.16 to 1.78) was found. When subjects with a
previous myocardial infarction or stroke were excluded, odds ratios
were 1.57 (95% CI, 1.27 to 1.94) for stroke and 1.51 (95% CI, 1.18 to
1.92) for myocardial infarction. Additional adjustment for several
cardiovascular risk factors attenuated these
associations: 1.34 (95% CI, 1.08 to 1.67) and 1.25 (95% CI, 0.98 to
1.58), respectively.
Conclusions The present study, based on a short follow-up period, provides evidence that an increased common carotid IMT is associated with future cerebrovascular and cardiovascular events.
Key Words: atherosclerosis • ultrasonics • risk factors
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