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European Heart Journal Advance Access originally published online on April 11, 2005
European Heart Journal 2005 26(12):1213-1220; doi:10.1093/eurheartj/ehi254
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Carotid stiffness and the risk of new vascular events in patients with manifest cardiovascular disease. The SMART study

Joke M. Dijk1, Ale Algra1,2,3, Yolanda van der Graaf1, Diederick E. Grobbee1, Michiel L. Bots1,* on behalf of the SMART study group

1Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Huispostnummer Str. 6.131, PO Box 85060, 3508 BA Utrecht, The Netherlands
2Department of Neurology, Rudolph Magnus Institute for Neuroscience, University Medical Center Utrecht,Utrecht, The Netherlands
3Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

Received 15 December 2004; revised 24 February 2005; accepted 3 March 2005; online publish-ahead-of-print 11 April 2005.

* Corresponding author. Tel: +31 30 2509352; fax: +31 30 2505485. E-mail address: m.l.bots@jc.azu.nl

See page 1152 for the editorial comment on this article (doi:10.1093/eurheartj/ehi280)

Aims To study whether arterial stiffness is related to risk of new vascular events in patients with manifest arterial disease and to examine whether this relation varies between patients who differ with respect to baseline vascular risk, arterial stiffness, or systolic blood pressure (SBP).

Methods and results The study was performed in the first consecutive 2183 patients with manifest arterial disease enrolled in the SMART study (Second Manifestations of ARTerial disease), a cohort study among patients with manifest arterial disease or cardiovascular risk factors. Common carotid distension (i.e. the change in carotid diameter in systole relative to diastole) was measured at baseline by ultrasonography. With the distension, several stiffness parameters were determined. In the entire cohort, none of the carotid artery stiffness parameters was related to the occurrence of vascular events. However, decreased stiffness was related to decreased vascular risk in subjects with low baseline SBP. The relation of carotid stiffness with vascular events did not differ between tertiles of baseline risk and carotid stiffness.

Conclusion Carotid artery stiffness is no independent risk factor for vascular events in patients with manifest arterial disease. However, in patients with low SBP, decreased carotid stiffness may indicate a decreased risk of vascular events.

Key Words: Elasticity • Cardiovascular diseases • Risk factors • Mortality • Carotid arteries


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