Incident stroke is associated with common carotid artery diameter and not common carotid artery intima-media thickness

Abstract

Background and purpose: The common carotid artery interadventitial diameter is measured on ultrasound images as the distance between the media-adventitia interfaces of the near and far walls. It is associated with common carotid intima-media thickness (IMT) and left ventricular mass and might therefore also have an association with incident stroke.

Methods: We studied 6255 individuals free of coronary heart disease and stroke at baseline with mean age of 62.2 years (47.3% men), members of a multiethnic community-based cohort of whites, blacks, Hispanics, and Chinese. Ischemic stroke events were centrally adjudicated. Common carotid artery interadventitial diameter and IMT were measured. Cases with incident atrial fibrillation (n=385) were excluded. Multivariable Cox proportional hazards models were generated with time to ischemic event as outcome, adjusting for risk factors.

Results: There were 115 first-time ischemic strokes at 7.8 years of follow-up. Common carotid artery interadventitial diameter was a significant predictor of ischemic stroke (hazard ratio, 1.86; 95% confidence interval, 1.59-2.17 per millimeter) and remained so after adjustment for risk factors and common carotid IMT with a hazard ratio of 1.52/mm (95% confidence interval, 1.22-1.88). Common carotid IMT was not an independent predictor after adjustment (hazard ratio, 0.14; 95% confidence interval, 0.14-1.19).

Conclusions: Although common carotid IMT is not associated with stroke, interadventitial diameter of the common carotid artery is independently associated with first-time incident ischemic stroke even after adjusting for IMT. Our hypothesis that this is in part attributable to the effects of exposure to blood pressure needs confirmation by other studies.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT00063440.

Keywords: carotid arteries; risk factors; stroke; ultrasonography.

Conflict of interest statement

Conflict-of-Interest/Disclosure:

Daniel H. O’Leary owns stock and is an employee of Medpace, Inc., a clinical research organization.

Figures

Figure 1

a. Kaplan-Meier curves for incident ischemic stroke by quartiles of increasing common carotid artery inter-adventitial diameter (IAD) without adjustment for risk factors. Quartile ranges were 3.97 to 6.92 mm, 6.93 to 7.43 mm, 7.49 to 8.12 mm and greater than 8.13 mm. Level of significance was p

Figure 1

a. Kaplan-Meier curves for incident ischemic stroke by quartiles of increasing common carotid artery inter-adventitial diameter (IAD) without adjustment for risk factors. Quartile ranges were 3.97 to 6.92 mm, 6.93 to 7.43 mm, 7.49 to 8.12 mm and greater than 8.13 mm. Level of significance was p