European Heart Journal Advance Access originally published online on July 11, 2006
European Heart Journal 2006 27(16):1971-1978; doi:10.1093/eurheartj/ehl136
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Carotid intima–media thickness and the risk of new vascular events in patients with manifest atherosclerotic disease: the SMART study
1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer Str.6.131, PO Box 85060, 3508 BA Utrecht, The Netherlands
2 Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
3 Rudolph Magnus Institute for Neuroscience, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
4 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
Received 11 January 2006; revised 22 May 2006; accepted 15 June 2006; online publish-ahead-of-print 11 July 2006.
* Corresponding author. Tel: +31 31 30 2509350; fax: +31 31 30 2505485. E-mail address: a.algra{at}umcutrecht.nl
Aims Carotid intima–media thickness (CIMT) is an independent predictor of vascular events in the general population. Currently, little is known about the relationship between CIMT and new vascular events in patients with manifest arterial disease. We aimed to assess the strength of this relationship.
Methods and results The study was performed in the first consecutive 2374 patients with manifest arterial disease enrolled in the cohort study SMART (Second Manifestations of ARTerial disease), a cohort study among patients with manifest arterial disease or cardiovascular risk factors. Common CIMT was measured at baseline in both carotid arteries. Vascular events were vascular death, non-fatal myocardial infarction, or stroke, whichever occurred first.
Adjusted for age and sex, an increase in common CIMT of 1 SD (
0.32 mm) was associated with the occurrence of vascular events [hazard ratio (HR) 1.18; 95% confidence interval (95% CI) 1.04–1.32]. Increasing CIMT was most strongly related to ischaemic stroke incidence (HR 1.35; 95% CI 1.16–1.59). Results were similar in the 2177 patients without large common carotid plaques (CIMT <2 mm at all measurements sites). The findings were similar after additional adjustment for risk factors of CIMT and vascular risk.
Conclusion Common CIMT is associated with the occurrence of new vascular events, mostly for ischaemic stroke, in patients with manifest arterial disease. This relation does not appear to depend on the presence of plaques.
Key Words: Intima–media thickness • Epidemiology • Risk factors • Clinical studies • Cardiovascular diseases
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