Affiliation:
1. Ultrasound Reading Center, Tufts Medical Center, Boston, MA
2. Department of Radiology, Tufts Medical Center, Boston, MA
3. Department of Epidemiology, Johns Hopkins University, Baltimore, MD
Abstract
Background
Common carotid artery and internal carotid artery intima‐media thicknesses (
IMT
) are associated with coronary heart disease (
CHD
) and increase with age. Using age, sex, and race/ethnicity
IMT
percentiles may improve
CHD
prediction when added to Framingham risk factors and coronary artery calcium score. We study these possibilities in the Multi‐Ethnic Study of Atherosclerosis (MESA), a multi‐ethnic cohort of whites, Chinese, blacks, and Hispanics.
Methods and Results
IMT
data were acquired in the age range 45 to 84 years. Common carotid artery and internal carotid artery
IMT
, sex, and race/ethnic specific normative values were calculated for each
MESA
participant and combined as an
IMT
score. Multivariable Cox‐proportional hazards models and logistic regression models were generated with
CHD
as outcome adding the
IMT
score to (1) a base model with Framingham risk factors, sex, race/ethnicity and (2) the base model with coronary artery calcium added. Harrell's C‐statistics and area under the curve were estimated. Median follow‐up was 10.2 years (interquartile range: 9.7, 10.7 years) with 429 first‐time
CHD
events. Mean age was 62.1 years and 52.6% of participants were women.
IMT
score increased the base area under the curve from 0.7210 to 0.7396 (
P
=0.0008) and with positive coronary artery calcium score added to the model, from 0.7627 to 0.7714 (
P
=0.02).
Conclusions
A carotid
IMT
score based on normative data incrementally adds to Framingham risk factors and a positive calcium score in predicting first‐time
CHD
in an ethnically diverse cohort.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
50 articles.
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