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European Heart Journal Advance Access published online on April 11, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi254
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European Heart Journal © The European Society of Cardiology 2005; All rights reserved
Received December 15, 2004
Revised February 24, 2005
Accepted March 3, 2005

Clinical research

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

Joke M. Dijk 1, Ale Algra 2, Yolanda van der Graaf 1, Diederick E. Grobbee 1, and Michiel L. Bots 1*

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

* To whom correspondence should be addressed.
Michiel L. Bots, E-mail: m.l.bots{at}jc.azu.nl


  Abstract

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.

Keywords: Elasticity; Cardiovascular diseases; Risk factors; Mortality; Carotid arteries.
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