Changes in carotid intima-media thickness during the cardiac cycle: the multi-ethnic study of atherosclerosis

Joseph F Polak, Craig Johnson, Anita Harrington, Quenna Wong, Daniel H O'Leary, Gregory Burke, N David Yanez, Joseph F Polak, Craig Johnson, Anita Harrington, Quenna Wong, Daniel H O'Leary, Gregory Burke, N David Yanez

Abstract

Background: Common carotid artery intima-media thickness (IMT), a measure of subclinical cardiovascular disease, changes during the cardiac cycle. The magnitude of this effect and its implications have not been well studied.

Methods and results: Far-wall IMT measurements of the right common carotid artery were measured at end diastole and peak systole in 5633 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). Multivariable regression models were generated with end-diastolic IMT, peak-systolic IMT, and change in IMT during the cardiac cycle as dependent variables and traditional cardiovascular risk factors as independent variables. The average age of our population was 61.9 (45 to 84) years. Average change in carotid IMT during the cardiac cycle was 0.041 mm (95% confidence interval: 0.039 to 0.042 mm), with a mean IMT of 0.68 mm. End-diastolic IMT and peak-systolic IMT were similarly associated with risk factors. In a fully adjusted model, change in carotid IMT during the cardiac cycle was associated with ethnicity and pulse pressure (P=0.001) and not age, sex, or other risk factors. Chinese and Hispanics had less of a change in IMT than did non-Hispanic whites. With peak-systolic IMT reference values used as normative data, 31.3% more individuals were classified as being in the upper quartile of IMT and at high risk for cardiovascular disease than would be expected when IMT is measured at end diastole.

Conclusions: Measurable differences in IMT are seen during the cardiac cycle. This affects the interpretation of IMT measurements used for cardiovascular risk assessment, given published normative data with IMT measured at peak systole.

Clinical trial registration: URL: www.ClinicalTrials.gov. Unique identifier: NCT00063440. (J Am Heart Assoc. 2012;1:e001420 doi: 10.1161/JAHA.112.001420.).

Keywords: atherosclerosis; blood pressure; carotid arteries; diastole; epidemiology; risk factors; systole; ultrasonics.

Figures

Figure 1.
Figure 1.
The mean common carotid artery IMT in millimeters is plotted for men and women as a function of 4 age categories. The ED-IMT values are consistently larger than the PS values. In addition, the magnitude of this difference is larger than the sex difference between men and women in the same age groups. IMT indicates intima-media thickness; ED, end diastole; and PS, peak systole.
Figure 2.
Figure 2.
The cumulative distribution of common carotid artery IMT values based on the PS values as done in the Atherosclerosis Risk in Communities (ARIC) study is shown as the curve to the left. When an IMT measurement is made at ED, the 75th percentile cutpoint for IMT values is shifted down, increasing the number of individuals classified as being at high risk (blue area). Individuals in the shaded area are inappropriately classified as being in a high-risk category. In this case, 31.3% of individuals in the third quartile are classified as being in the upper quartile, equivalent to a relative increase of 31.3% in the high-risk group defined as having an IMT value >75% cutpoint. IMT indicates intima-media thickness; PS, peak systole; and ED, end diastole.

References

    1. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007;115:459-467
    1. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK., Jr Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14-22
    1. Boutouyrie P, Germain DP, Tropeano AI, Laloux B, Carenzi F, Zidi M, Jeunemaitre X, Laurent S. Compressibility of the carotid artery in patients with Pseudoxanthoma elasticum. Hypertension. 2001;38:1181-1184
    1. Selzer RH, Mack WJ, Lee PL, Kwong-Fu H, Hodis HN. Improved common carotid elasticity and intima-media thickness measurements from computer analysis of sequential ultrasound frames. Atherosclerosis. 2001;154:185-193
    1. Meinders JM, Kornet L, Hoeks AP. Assessment of spatial inhomogeneities in intima media thickness along an arterial segment using its dynamic behavior. Am J Physiol Heart Circ Physiol. 2003;285:H384-H391
    1. Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Jr, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2010;122:2748-2764
    1. Naghavi M, Falk E, Hecht HS, Jamieson MJ, Kaul S, Berman D, Fayad Z, Budoff MJ, Rumberger J, Naqvi TZ, Shaw LJ, Faergeman O, Cohn J, Bahr R, Koenig W, Demirovic J, Arking D, Herrera VLM, Badimon J, Goldstein JA, Rudy Y, Airaksinen J, Schwartz RS, Riley WA, Mendes RA, Douglas P, Shah PK, Force ST. From vulnerable plaque to vulnerable patient—Part III: executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force Report. Am J Cardiol. 2006;98:2H-15H
    1. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WSAmerican Society of Echocardiography Carotid Intima-Media Thickness Task Force Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008;21:93-111
    1. Howard G, Sharrett AR, Heiss G, Evans GW, Chambless LE, Riley WA, Burke GL. Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC Investigators. Stroke. 1993;24:1297-1304
    1. Bild DE, Bluemke DA, Burke GL, Detrano R, Diez Roux AV, Folsom AR, Greenland P, Jacob DR, Jr, Kronmal R, Liu K, Nelson JC, O'Leary D, Saad MF, Shea S, Szklo M, Tracy RP. Multi-Ethnic Study of Atherosclerosis: objectives and design. Am J Epidemiol. 2002;156:871-881
    1. Polak JF, Pencina MJ, O'Leary DH, D'Agostino RB. Common carotid artery intima-media thickness progression as a predictor of stroke in Multi-Ethnic Study of Atherosclerosis. Stroke. 2011;42:3017-3021
    1. Genuth S, Alberti KGMM, Bennett P, Buse J, Defronzo R, Kahn R, Kitzmiller J, Knowler WC, Lebovitz H, Lernmark A, Nathan D, Palmer J, Rizza R, Saudek C, Shaw J, Steffes M, Stern M, Tuomilehto J, Zimmet PExpert Committee on the Diagnosis and Classification of Diabetes Mellitus Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26:3160-3167
    1. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499-502
    1. O'Leary DH, Polak JF, Wolfson SK, Jr, Bond MG, Bommer W, Sheth S, Psaty BM, Sharrett AR, Manolio TA. Use of sonography to evaluate carotid atherosclerosis in the elderly: the Cardiovascular Health Study. CHS Collaborative Research Group. Stroke. 1991;22:1155-1163
    1. Zellner A. An efficient method of estimating seemingly unrelated regression equations and tests for aggregation bias. J Am Stat Assoc. 1962;57:348-368
    1. Carew TE, Vaishnav RN, Patel DJ. Compressibility of the arterial wall. Circ Res. 1968;23:61-68
    1. Girerd XJ, Acar C, Mourad JJ, Boutouyrie P, Safar ME, Laurent S. Incompressibility of the human arterial wall: an in vitro ultrasound study. J Hypertens Suppl. 1992;10:S111-S114
    1. Devereux RB, Waeber B, Roman MJ. Conclusions on the measurement of arterial wall thickness: anatomic, physiologic and methodologic considerations. J Hypertens Suppl. 1992;10:S119-S121
    1. Baldassarre D, Werba JP, Tremoli E, Poli A, Pazzucconi F, Sirtori CR. Common carotid intima-media thickness measurement: a method to improve accuracy and precision. Stroke. 1994;25:1588-1592
    1. Baldassarre D, Veglia F, Gobbi C, Gallus G, Ventura A, Crepaldi G, Fisicaro M, Rimondi S, Ricci G, Mancini M, Bong MG, Collatina S, Sirtori CR. Intima-media thickness after pravastatin stabilizes also in patients with moderate to no reduction in LDL-cholesterol levels: the Carotid Atherosclerosis Italian Ultrasound Study. Atherosclerosis. 2000;151:575-583
    1. Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu C, Alaupovic P, Kwong-Fu H, Azen SP. Reduction in carotid arterial wall thickness using lovastatin and dietary therapy: a randomized controlled clinical trial. Ann Intern Med. 1996;124:548-556
    1. Taylor AJ, Kent SM, Flaherty PJ, Coyle LC, Markwood TT, Vernalis MN. ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: a randomized trial comparing the effects of atorvastatin and pravastatin on carotid intima medial thickness. Circulation. 2002;106:2055-2060
    1. Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu CR, Liu CH, Azen SP. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med. 1998;128:262-269
    1. Polak JF, Person SD, Wei GS, Godreau A, Jacobs DR, Jr, Harrington A, Sidney S, O'Leary DH. Segment-specific associations of carotid intima-media thickness with cardiovascular risk factors: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Stroke. 2010;41:9-15
    1. O'Leary DH, Polak JF, Kronmal RA, Savage PJ, Borhani NO, Kittner SJ, Tracy R, Gardin JM, Price TR, Furberg CD. Thickening of the carotid wall: a marker for atherosclerosis in the elderly? Cardiovascular Health Study Collaborative Research Group. Stroke. 1996;27:224-231
    1. AnonymousAtherosclerosis Risk in Communities Study Protocol. Manual 6. Ultrasound Assessment Part B: Ultrasound Reading. 1989Chapel Hill, NC: ARIC Coordinating Center; 68-70Version 1
    1. Nambi V, Chambless L, Folsom AR, He M, Hu Y, Mosley T, Volcik K, Boerwinkle E, Ballantyne CM. Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease: the ARIC (Atherosclerosis Risk in Communities) Study. J Am Coll Cardiol. 2010;55:1600-1607
    1. Polak JF, Pencina MJ, Pencina KM, O'Donnell CJ, Wolf PA, D'Agostino RB., Sr Carotid-wall intima-media thickness and cardiovascular events. N Engl J Med. 2011;365:213-221

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