Abstract 3113: Rapid Progression of Intima-Media Thickness of Carotid Plaque Despite Individualized and Optimized Therapy for Cardiovascular Risk Factors Predicts a Worse Outcome in Patients with Coronary Artery Disease
Carotid intima-media thickness (IMT) has a predictive value for cardiovascular disease (CVD) events. Several clinical trials showed that carotid IMT is changed in response to therapy of single risk factor reduction over several years. However, it is unclear whether changes in carotid IMT in response to individualized and optimized therapy for CVD risk during a shorter period may have predictive value in patients with coronary artery disease (CAD). Thus, this study examined whether changes in carotid IMT in response to optimized therapy for CVD risk for 6 months provide prognostic information on future CVD events in patients with CAD. This study included 201 consecutive patients with newly diagnosed CAD who had a carotid plaque (IMT > 1.1 mm) at baseline. After enrollment, all patients had individualized, optimized therapy including medications and life style changes based on AHA guidelines to reduce CVD risk factors. A carotid ultrasound examination was repeated at entry and after 6 months. The atherosclerotic plaque with the greatest axial thickness in the carotid arteries at entry was targeted for monitoring the change in IMT (maxIMT). Thereafter, patients were prospectively followed-up for 3 years or until the occurrence of 1 of the following events: CVD death, nonfatal myocardial infarction, unstable angina pectoris requiring revascularization, and ischemic stroke. The mean change of maxIMT over 6 months was + 0.02 ± 0.02 mm. During follow-up, 40 events occurred (CVD death in 3, myocardial infarction in 8, unstable angina in 23, stroke in 6). In Kaplan-Meier analysis, the CVD events were highly frequent in the highest tertile of maxIMT change (≥ 0.20 mm) (21 events) compared with the lowest tertile (< − 0.18 mm) (6 events) (p < 0.01 by log-rank test). In a multivariate Cox proportional hazards model, the highest tertile of maxIMT change predicted CVD events, that was independent of maxIMT at entry, use of medications, age, and traditional CVD risk factors (HR; 2.6, 95% CI; 1.3 – 5.1, p < 0.01). The high progression of carotid plaque IMT despite the optimized therapy for CVD risk for 6 months is associated with a worse outcome in patients with CAD. Periodic measurement of carotid plaque IMT may be useful for risk stratification in CAD.