Carotid Intima-Media Thickness Score, Positive Coronary Artery Calcium Score, and Incident Coronary Heart Disease: The Multi-Ethnic Study of Atherosclerosis

J Am Heart Assoc. 2017 Jan 21;6(1):e004612. doi: 10.1161/JAHA.116.004612.

Abstract

Background: Common carotid artery and internal carotid artery intima-media thicknesses (IMT) are associated with coronary heart disease (CHD) and increase with age. Using age, sex, and race/ethnicity IMT percentiles may improve CHD prediction when added to Framingham risk factors and coronary artery calcium score. We study these possibilities in the Multi-Ethnic Study of Atherosclerosis (MESA), a multi-ethnic cohort of whites, Chinese, blacks, and Hispanics.

Methods and results: IMT data were acquired in the age range 45 to 84 years. Common carotid artery and internal carotid artery IMT, sex, and race/ethnic specific normative values were calculated for each MESA participant and combined as an IMT score. Multivariable Cox-proportional hazards models and logistic regression models were generated with CHD as outcome adding the IMT score to (1) a base model with Framingham risk factors, sex, race/ethnicity and (2) the base model with coronary artery calcium added. Harrell's C-statistics and area under the curve were estimated. Median follow-up was 10.2 years (interquartile range: 9.7, 10.7 years) with 429 first-time CHD events. Mean age was 62.1 years and 52.6% of participants were women. IMT score increased the base area under the curve from 0.7210 to 0.7396 (P=0.0008) and with positive coronary artery calcium score added to the model, from 0.7627 to 0.7714 (P=0.02).

Conclusions: A carotid IMT score based on normative data incrementally adds to Framingham risk factors and a positive calcium score in predicting first-time CHD in an ethnically diverse cohort.

Keywords: atherosclerosis; cardiovascular outcomes; carotid artery; coronary artery calcification; coronary artery disease; epidemiology; intima‐media thickness; risk assessment; risk factors; ultrasound.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Asian / statistics & numerical data
  • Black or African American / statistics & numerical data
  • Carotid Artery, Common / diagnostic imaging
  • Carotid Artery, Internal / diagnostic imaging
  • Carotid Intima-Media Thickness*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology*
  • Coronary Disease / epidemiology*
  • Female
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Tomography, X-Ray Computed
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / epidemiology*
  • White People / statistics & numerical data