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Carotid plaque measurement is superior to IMT

Invited editorial comment on: Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: A meta-analysis—Yoichi Inaba, M.D., Jennifer A. Chen M.D., Steven R. Bergmann M.D., Ph.D.
  • J. David Spence
    Correspondence
    Tel.: +1 519 663 3113; fax: +1 519 663 3018.
    Affiliations
    Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, University of Western Ontario, 1400 Western Road, London, ON, Canada N6G 2V2
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      In this issue of Atherosclerosis, Inaba et al. [
      • Inaba Y.
      • Chen J.A.
      • Bergmann S.R.
      Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis.
      ] provide further evidence, in form of a meta-analysis, that measurement of carotid plaque is more strongly predictive of cardiovascular events than is measurement of carotid intima-media thickness (IMT). This was previously noted by Johnsen and Mathiesen [
      • Johnsen S.H.
      • Mathiesen E.B.
      Carotid plaque compared with intima-media thickness as a predictor of coronary and cerebrovascular disease.
      ]. The most important studies to show this are those from the Tromsø study, a prospective population-based study in over 6000 participants who were healthy at baseline. The Tromsø study is the only large prospective study in which both total plaque area (TPA) and IMT were measured. In their report after 6 years of followup [
      • Johnsen S.H.
      • Mathiesen E.B.
      • Joakimsen O.
      • et al.
      Carotid atherosclerosis is a stronger predictor of myocardial infarction in women than in men: a 6-year follow-up study of 6226 persons: the Tromso Study.
      ], they found that baseline IMT in the distal common carotid did not predict myocardial infarction (MI), whereas IMT in the bulb was predictive, and TPA was more strongly predictive. In the report after 10 years of followup [
      • Mathiesen E.B.
      • Johnsen S.H.
      • Wilsgaard T.
      • et al.
      Carotid plaque area and intima-media thickness in prediction of first-ever ischemic stroke: a 10-year follow-up of 6584 men and women: the Tromso study.
      ], they found that IMT did not predict stroke, whereas TPA was strongly predictive.
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      Linked Article

      • Time course of atherosclerosis regression
        AtherosclerosisVol. 235Issue 2
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          The recent review of the time course of atherosclerosis regression [1] vastly overstates the time required to image regression of atherosclerosis by lipid-lowering therapy. The authors say “Regression of atherosclerotic plaque using statin therapy in those studies documenting regression occurred after an average time of 19.7 months. This suggests that patients should undergo approximately two years of aggressive lipid reduction before considering a reduction of statin therapy”. There are a couple of problems with these pronouncements.
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