Site-specific progression of carotid artery intimal-medial thickness


      Purpose: To characterize the intercorrelation of changes in intimal-medial thickness (IMT) among carotid artery sites and examine the influence of diabetes and sex on these correlations. Methods: Ultrasonographic IMT measurements from the near and far walls of common and internal segments in the arteries of 1207 participants of the Insulin Resistance Atherosclerosis Study (IRAS) were analyzed to estimate the underlying correlations of IMT changes (average of 5.2 years) among artery sites after correction for measurement error. Results: Differences in IMT progression associated with diabetes and sex were evident at all sites. IMT changes were strongly correlated between left and right arteries (r=0.32–0.73) and near and far walls (r=0.42–0.87). Correlations of IMT changes at corresponding sites of internal versus common segments were reduced from r=0.32 among normal individuals to r=0.09 among those with diabetes, but were similar for women and men. Conclusions: IMT progression is a diffuse process involving all carotid artery sites. Diabetes does not influence the bilateral and radial nature of progression, but reduces the correlation between distal sites within an artery. Pooling measurements across arteries and walls often yields the most efficient analyses.


      ACAPS (Asymptomatic Carotid Artery Progression Study), IGT (impaired glucose tolerance), IMT (intimal-medial thickness), IRAS (Insulin Resistance Atherosclerosis Study), MVN (multivariate normal), NGT (normal glucose tolerance), WHO (World Health Organization)


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        • Polak J.F.
        • O’Leary D.H.
        • Kronmal R.A.
        • Wolfson S.K.
        • Bond M.G.
        • Tracy R.P.
        • et al.
        Sonographic evaluation of carotid artery atherosclerosis in the elderly: relationship of disease severity to stroke and transient ischemic attack.
        Radiology. 1993; 188: 363-370
        • Howard G.
        • Burke G.L.
        • Evans G.W.
        • Crouse III, J.R.
        • Riley W.
        • Arnett D.
        • et al.
        Relations of intimal-medial thickness among sites within the carotid artery as evaluated by B-mode ultrasound. ARIC Investigators. Atherosclerosis Risk in Communities.
        Stroke. 1994; 25: 1581-1587
        • Salonen J.T.
        • Salonen R.
        Risk factors for carotid and femoral atherosclerosis in hypercholestoraemic men.
        J. Intern. Med. 1994; 236: 561-566
        • Crouse J.R.
        • Craven T.E.
        • Hagaman A.P.
        • Bond M.G.
        Association of coronary disease with segment-specific intimal-medial thickening of the extracranial carotid artery.
        Circulation. 1995; 92: 1141-1147
        • Davis P.H.
        • Dawson J.D.
        • Mahoney L.T.
        • Lauer R.M.
        Increased carotid intimal-medial thickness and coronary calcification are related in young and middle-aged adults. The Muscatine Study.
        Circulation. 1998; 98: 1504-1509
        • van Popele N.M.
        • Grobbee D.E.
        • Bots M.L.
        • Asmar R.
        • Topouchian J.
        • Reneman R.S.
        • et al.
        Association between arterial stiffness and atherosclerosis in the Rotterdam Study.
        Stroke. 2001; 32: 454-460
        • Allan P.K.
        • Mowbray P.I.
        • Fowlkes F.G.
        Relationship between carotid intima-media thickness and symptomatic and asymptomatic peripheral arterial disease. The Edinburgh Artery Study.
        Stroke. 1997; 28: 348-353
        • Hedblad B.
        • Wikstrand J.
        • Janzon L.
        • Wedel H.
        • Berglund G.
        Low-dose metoprolol CR/XL and fluvastatin slow progression of carotid intima-media thickness.
        Circulation. 2001; 103: 1721-1726
        • Wagenknecht L.E.
        • Mayer E.J.
        • Rewers M.
        • Haffner S.M.
        • Selby J.
        • Borok G.M.
        • et al.
        The Insulin Resistance Atherosclerosis Study: design.
        Ann. Epidemiol. 1995; 5: 464-472
        • Riley W.A.
        • Barnes R.
        • Applegate W.B.
        • Dempsey R.
        • Hartwell T.
        • Davis V.G.
        • et al.
        Reproducibility of noninvasive ultrasonic measurement of carotid atherosclerosis: the Asymptomatic Carotid Artery Plaque Study.
        Stroke. 1992; 23: 1062-1068
        • Espeland M.A.
        • Craven T.E.
        • Miller M.E.
        • D’Agostino Jr., R.
        Modeling multivariate longitudinal data that are incomplete.
        Ann. Epidemiol. 1999; 9: 196-205
      1. Carroll RJ, Ruppert D, Stefanski LA. Measurement error in nonlinear models. Boca Raton (FA): Chapman & Hall/CRC; 1998.

      2. Gilks WR, Richardson S, Spiegelhalter DJ. Introducing Markov chain Monte Carlo. In: Gilks WR, Richardson S, Spiegelhalter DJ, editors. Markov chain Monte Carlo in practice. London: Chapman & Hall; 1996. p. 1–21.

      3. Spiegelhalter D, Thomas A, Best N, Gilks W. BUGS 0.5: Bayesian inference Using Gibbs Sampling Manual (version ii). Cambridge (England): MRC Biostatistics Unit; 1996.

      4. Wagenknecht LE, Zaccaro D, Espeland MA, Karter AJ, O’Leary D, Haffner SM. Diabetes and progression of carotid atherosclerosis: The Insulin Resistance Atherosclerosis Study, Arterioscler Thromb Vasc Biol 2003;23:1035–41.

        • Furberg C.D.
        • Byington R.P.
        • Craven T.E.
        Lessons learned from clinical trials with ultrasound end-points.
        J. Intern. Med. 1994; 236: 575-580
        • Masawa N.
        • Galgov S.
        • Zarins C.K.
        Quantitative morphologic study of intimal thickening at the human carotid bifurcation: axial and circumferential distribution of maximum intimal thickening in asymptomatic, uncomplicated plaques.
        Atherosclerosis. 1994; 107: 137-146
        • Smedby O.
        • Johansson J.
        • Molgaard J.
        • Olsson A.G.
        • Walldius G.
        • Erikson U.
        Predilection of atherosclerosis for the inner curvature in the femoral artery: a digitized angiography study.
        Arterioscler Thromb. Vasc. Biol. 1995; 15: 912-917
        • Espeland M.A.
        • Craven T.E.
        • Riley R.A.
        • Corson J.
        • Romont A.
        • Furberg C.D.
        Reliability of longitudinal ultrasonographic measurements of carotid intimal-medial thickness.
        Stroke. 1996; 27: 480-485
        • Hodis H.N.
        • Mack W.J.
        • LaBree L.
        • Selzer R.H.
        • Liu C.-R.
        • Liu C.-H.
        The role of arterial intima-media thickness in predicting clinical coronary events.
        Ann. Intern. Med. 1998; 128: 262-269
      5. Crouse J, Tang R, Espeland MA, Terry JG, Morgan T, Mercuri M. Associations of extracranial carotid atherosclerosis progression with coronary status and risk factors in patients with and without coronary artery disease, Circulation 2002; 106:2061–6.

        • Shincore A.M.
        • Mack W.J.
        • Selzer R.H.
        • Lee P.L.
        • Azen S.P.
        • Alaupovic P.
        • et al.
        Compensatory vascular changes of remote coronary segments in response to lesion progression as observed by sequential angiography from a controlled clinical trial.
        Circulation. 1995; 92: 2144-2418
        • Kiechl S.
        • Willeit S.
        The natural course of atherosclerosis. Part II. Vascular remodeling.
        Arterioscler Thromb. Vasc. Biol. 1999; 19: 1491-1498
        • Yanez N.D.
        • Kronmal R.A.
        • Shemanski L.R.
        The effects of measurement error in response variables and tests of association of explanatory variables in change models.
        Statist. Med. 1998; 17: 2597-2606
        • Kiechl S.
        • Willeit J.
        The natural course of atherosclerosis. Part I: incidence and [progression].
        Aterioscler Thromb. Vasc. Biol. 1999; 19: 1484-1490