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CLINICAL RESEARCH: NON-CARDIAC FINDINGS AND CORONARY ATHEROSCLEROSIS

Prevalence of specific variant carotid geometric patterns and incidence of cardiovascular events in older persons

The cardiovascular health study (CHS E-131)¹

Angelo Scuteri, MD, PhD^*,*, Teri A. Manolio, MD, PhD, Emily K. Marino, MS, Alice M. Arnold, PhD and Edward G. Lakatta, MD^*

^* Laboratory of Cardiovascular Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Collaborative Health Studies Coordinating Center, Department of Biostatistics, University of Washington, Seattle, Washington, USA

Manuscript received February 14, 2003; revised manuscript received August 18, 2003, accepted August 25, 2003.

^* Reprint requests and correspondence: Dr. Angelo Scuteri, Laboratory of Cardiovascular Science, National Institute on Aging-NIH, 5600 Nathan Shock Drive, Baltimore, Maryland 21224.
scuteria{at}grc.nia.nih.gov

OBJECTIVES: We hypothesized that variant geometric patterns of the common carotid artery (CCA) predict the incidence of cardiovascular disease (CVD), after accounting for CCA intima-medial thickness (IMT).

BACKGROUND: Common carotid artery intima-media thickness has been associated with the incidence of cardiovascular disease.

METHODS: Noninvasive measurements of IMT were made with high-resolution ultrasonography in 5,640 subjects 65 years of age or older participating in the Cardiovascular Health Study. New coronary and/or cerebrovascular events served as outcome variables over a median 10.2-year follow-up. To characterize different carotid structural geometric patterns (CGP), vascular mass (VM) was combined with the wall-to-lumen ratio (W/L). Normal values for W/L and VM were defined as age-adjusted, gender-specific 75th percentiles of the 1,899 normotensive subjects free of CVD at baseline. Four CGPs were defined: CGP1 = normal W/L ratio and VM; CGP2 = arterial remodeling (i.e., increased W/L ratio with normal VM); CGP3 = arterial hypertrophy (i.e., increased W/L ratio with increased VM); and CGP4 = arterial hypertrophy with dilation (i.e., normal W/L ratio and increased VM).

RESULTS: Coronary or cerebrovascular events (adjusted for age, gender, traditional risk factors, and IMT) were associated with CGP in subjects free of CVD at baseline. Specifically, the hazard ratio (Cox proportional-hazards analyses) for CGP3 (arterial hypertrophy) was 1.25 (95% confidence interval [CI] 1.03 to 1.53), and for CGP4 (arterial hypertrophy with dilation) was 1.43 (95% CI 1.16 to 1.75) compared with CGP1 (normal).

CONCLUSIONS: Arterial hypertrophy defined by variant CGP patterns is associated with the development of new CVD, independent of age, traditional risk factors, and CCA IMT.

Abbreviations and Acronyms   BP = blood pressure   CCA = common carotid artery   CeVD = cerebrovascular disease   CGP = carotid geometric pattern   CHD = coronary heart disease   CHS = Cardiovascular Health Study   CI = confidence interval   CVD = cardiovascular disease   HR = hazard ratio   IMT= intima-media thickness   SD = standard deviation   VM = vascular mass   W/L = wall-to-lumen ratio

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