Abstract 13988: Independent Effects of Risk Factors and Treatment on Carotid Intima-Media Thickness Progression in a Community Practice
Background Although carotid intima-media thickness (CIMT) is a well-known predictor of CHD events, the risk factor and treatment determinants of CIMT progression in real world clinical practice are not well known.
Methods We retrospectively assembled a cohort of 448 consecutive patients with at least one follow-up CIMT, receiving care from a community-based prevention clinic. Treatment was based on statins, ACE inhibitors, niacin, ezetimibe, and antiplatelet therapy. Presence of plaque, plaque type, mean CIMT, maximum CIMT (max CIMT), and maximum minus mean CIMT (max-mean CIMT) were examined over follow-up, and mean CIMT was tested for independent associations with treatment and risk factors.
Results Median time to last CIMT was 2.6 years. Mean age was 55 years with 39% female. There were large changes in lipids, blood pressure, and medication usage in the first year of follow-up. There were significant changes in presence of plaque (p=0.037) and plaque type (p<0.001 for all types) over follow-up. Modest decreases in average mean CIMT and large decreases in average max and max-mean CIMT were observed within one year of follow-up (p<0.001 for all). Treatment-adjusted change in non-HDL-C was the best predictor of change in mean CIMT (0.0022, CI 0.0003, 0.0040 mm/10 mg/dL increase), while the lipid-modifying treatment type did not independently predict regression of mean CIMT (statin: -0.0062, CI -0.0154, 0.0029 mm/year; ezetimibe: 0.0125, CI -0.0027, 0.0277 mm/year; niacin: 0.0120, CI 0.0006, 0.0234 mm/year). Conclusions In this cohort of aggressively treated patients, we observed modest to marked changes in CIMT over multi-year follow up. Early year changes in mean CIMT were predicted by large changes in non-HDL-C but not specific type of lipid-lowering treatment. These results give insight into recent and current trials of multi-year aggressive lipid management with combinations of therapy on atherosclerotic burden.
- © 2012 by American Heart Association, Inc.