Abstract 20626: The Fastest Progression of Carotid Intima Media Thickness is Associated with Increased Vascular Events in the IMPROVE Study
Background: Progression of Carotid Intima Media Thickness (IMT) has been proposed as a potential biomarker of cardiovascular risk. However, this association remains controversial and has not been examined in “ad-hoc designed” large epidemiological studies.
Methods: We measured the 15-month IMT progression in 3703 European high risk patients (so defined for the presence of at least three vascular risk factors) enrolled in the IMPROVE Study, and assessed its association with cardiovascular events occurring during the subsequent 21.8 months of follow-up using a Cox proportional hazards model. Progression of mean and maximum IMT of the left and right common carotids, bifurcations, internal carotid arteries and of the whole carotid tree as well as the fastest IMT-progression detected in each carotid segment and in the whole carotid tree regardless of its location were computed and used in the statistical analyses.
Results: All ultrasonic variables significantly progressed during the 15th months, but only fastest IMT-progressions of bifurcation, internal carotid artery and of the whole carotid tree, were significantly associated with incident vascular events. The unadjusted hazard ratios (HR) for combined events (coronary, cerebral and vascular events pooled together) were 1.18 [1.05-1.33] (p=0.005), 1.15 [1.01-1.30] (p=0.03) and 1.19 [1.06-1.33] (p=0.004) for one standard deviation increase of the fastest IMT-progression detected in carotid bifurcations, internal carotid arteries and the whole carotid tree, respectively. These associations remained significant, or nearly significant, after adjustment for age, sex and baseline-IMT (p=0.009, p=0.06 and p=0.01) as well as after further adjustment for latitude, HDL-C, LDL-C, systolic blood pressure, diabetes, hypertension, pack-years and pharmacological treatments (p=0.09, p=0.03 and p=0.04).
Conclusions: The fastest carotid IMT-progression, being associated with an increased risk of CV events in high-risk European patients, represents a novel risk marker, and/or a potential target for therapy.
- © 2010 by American Heart Association, Inc.