European Heart Journal Advance Access originally published online on February 2, 2007
European Heart Journal 2007 28(4):398-406; doi:10.1093/eurheartj/ehl482
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Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations?
1 Julius Center for Health Sciences and Primary Care, Huispostnummer Str 6.131, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
2 Department of Pharmacological Sciences, E. Grossi Paoletti Center, University of Milan and Cardiologico ‘Monzino’, IRCCS, Milan, Italy
3 Centre de Medecine Preventive Cardiovasculaire, Hopital Broussais Assistance Publique Hopitaux de Paris-Faculte de Medecine Rene Descartes, Paris, France
4 Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
5 Department of Radiology, Tufts University School of Medicine, Boston, MA, USA
6 Department of Neurology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
Received 14 July 2006; revised 2 January 2007; accepted 4 January 2007; online publish-ahead-of-print 2 February 2007.
* Corresponding author. Tel: +31 30 2509352; fax: +31 30 2505485. E-mail address: m.l.bots{at}umcutrecht.nl
Aims Measurement of change in carotid intima-media thickness (CIMT) has been proposed as an alternative for the occurrence of cardiovascular (CV) events in the assessment of therapeutic interventions. Nevertheless, criticism has been voiced based on observations indicating a weak relation between CIMT and coronary atherosclerosis as well as on the virtual absence of data showing that progression of CIMT indeed predicts coronary artery disease (CAD) and stroke.
Methods and results We set out to review the evidence on these issues by performing a literature search on these topics. Of the 34 studies on the relation of CIMT with coronary atherosclerosis, as assessed by angiography (n = 33) or intravascular ultrasound (n = 1), 30 showed a modest positive relationship; the magnitude of which was similar to that found in autopsy studies. Of all studies on CIMT and future CV events (n = 18), 17 showed graded positive relationships. At present, only one study has provided evidence on the relation of change in CIMT and future CV events, showing an increased risk with CIMT progression. The paucity of data on progression and future CV risk is partly attributable to time windows required to complete these studies.
Conclusion The modest relation between CIMT and coronary atherosclerosis most likely reflects variability in atherosclerosis development between the vascular beds rather than limitations of CIMT measurements. Additional data on the relation between change in CIMT and future CV events is required and currently is in progress.
Key Words: Carotid atherosclerosis • Trials • Surrogate endpoints • Hypertension • Statin
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