European Heart Journal

European Heart Journal 2001 22(1):62-72; doi:10.1053/euhj.1999.2006
Copyright © 2001 by the European Society of Cardiology.

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Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris

C. Held^a,f1, P. Hjemdahl^b, S.V. Eriksson^a, I. Björkander^a, L. Forslund^c and N. Rehnqvist^d

^a Department of Medicine, Danderyd Hospital, Sweden
^b Departments of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Hospital, Sweden
^c Department of Medicine, Trelleborg Hospital, Trelleborg, Sweden
^d National Board of Health and Welfare, Stockholm, Sweden

revised November 7, 1999; accepted November 9, 1999

Abstract

Background Ultrasonographic assessments of intima-media thickness and plaques in the carotid artery are widely used as surrogate markers for coronary atherosclerosis, but prospective evaluations are scarce and appear to be lacking in patients with coronary artery disease. Ultrasonographic evaluations of femoral vascular changes have not been studied prospectively.

Methods and Results In the Angina Prognosis Study in Stockholm (APSIS), 809 patients with stable angina pectoris were studied prospectively during double-blind treatment with verapamil or metoprolol. Ultrasonographic assessments of intima-media thickness, lumen diameter and plaques in the carotid and femoral arteries were evaluated in a subgroup of 558 patients (182 females) with a mean age of 60±7 years, and related to the risk of cardiovascular death (n=18) or non-fatal myocardial infarction (n=26), or revascularization (n=70) during follow-up (median 3·0 years). Univariate Cox regression analyses showed that carotid intima-media thickness and plaques were related to the risk of cardiovascular death or myocardial infarction. Femoral intima-media thickness was related to cardiovascular death or myocardial infarction, as well as to revascularization, whereas femoral plaques were only related to the latter. After adjustment for age, sex, smoking, previous cardiovascular disease and lipid status, carotid intima-media thickness failed to predict any cardiovascular event, whereas carotid plaques tended (P=0·056) to predict the risk of cardiovascular death or myocardial infarction. Femoral intima-media thickness (P<0·01) and plaques (P<0·05) were also related to the risk of revascularization after adjustments.

Conclusions Carotid and femoral vascular changes were differently related to cardiovascular events. Carotid intima-media thickness was a weak predictor of events, whereas femoral intima-media thickness predicted revascularization. Plaques in the carotid artery were related to cardiovascular death or non-fatal myocardial infarction, whereas plaques in the femoral artery were related to revascularization. Evaluations of plaques provided better prediction than assessments of intima-media thickness in patients with stable angina.

Key Words: Ultrasound, carotid artery, femoral artery, intima-media thickness, plaques, atherosclerosis, angina pectoris, prognosis, risk factor

^f1 Correspondence: Claes Held, MD, PhD, Karolinska Institute, Department of Medicine, Danderyd Hospital, S-182 88 Danderyd, Sweden.

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