Short-term progression of maximum intima-media thickness of carotid plaque is associated with future coronary events in patients with coronary artery disease



      This study examined whether changes in maximum intima-media thickness of carotid plaque (plaque-IMTmax) over 6 months predict future coronary events in patients with carotid plaque and coronary artery disease (CAD).


      This study included 240 patients with CAD who had a carotid plaque (IMT ≥ 1.1 mm) at entry. A carotid ultrasound examination was performed at entry (1st test) and after 6 months (2nd test). The carotid plaque with the greatest axial thickness at the 1st test was selected as the target plaque for monitoring the change in plaque-IMTmax. After the 2nd test, patients were prospectively followed-up for 3 years or until the occurrence of one of the following coronary events: cardiac death, non-fatal myocardial infarction, or unstable angina pectoris requiring coronary revascularization.


      The change in plaque-IMTmax over 6 months ranged from −0.85 to 0.97 mm (mean, −0.006 ± 0.319 mm). There were 41 events during follow-up. In a stepwise multivariate Cox proportional hazards model, the change in plaque-IMTmax was a significant predictor of coronary events after adjustment for known risk factors (HR per 0.1 mm increase over 6 months, 1.21; 95%CI, 1.10–1.33, p = 0.0001). Analysis of receiver operating characteristic (ROC) curves showed that the addition of the change in plaque-IMTmax to conventional risk factors resulted in a greater area under the ROC curve compared with conventional risk factors alone (0.81 and 0.70, respectively, p = 0.02).


      Short-term progression of carotid plaque-IMTmax was associated with future coronary events in patients with CAD.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rothwell P.M.
        • Villarga R.
        • Gibson R.
        • Donders R.C.
        • Warlow C.P.
        Evidence of a chronic systemic cause of instability of atherosclerotic plaques.
        Lancet. 2000; 355: 19-24
        • Libby P.
        Vascular biology of atherosclerosis: overview and state of the art.
        Am J Cardiol. 2003; 91: 3A-6A
        • Simon A.
        • Megnien J.L.
        • Chironi G.
        The value of carotid intima-media thickness for predicting cardiovascular risk.
        Arterioscler Thromb Vasc Biol. 2010; 30: 182-185
        • Nguyen-Thanh H.T.
        • Benzaquen B.S.
        Screening for subclinical coronary artery disease measuring carotid intima media thickness.
        Am J Cardiol. 2009; 104: 1383-1388
        • Heiss G.
        • Sharrett A.R.
        • Barnes R.
        • et al.
        Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study.
        Am J Epidemiol. 1991; 134: 250-256
        • de Groot E.
        • van Leuven S.I.
        • Duivenvoorden R.
        • et al.
        Measurement of carotid intima-media thickness to assess progression and regression of atherosclerosis.
        Nat Clin Pract Cardiovasc Med. 2008; 5: 280-288
        • Hodis H.N.
        • Mack W.J.
        • LaBree L.
        • et al.
        The role of carotid arterial intima-media thickness in predicting clinical coronary events.
        Ann Intern Med. 1998; 128: 262-269
        • O’Leary D.H.
        • Polak J.F.
        • Kronmal R.A.
        • et al.
        Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults.
        N Engl J Med. 1999; 340: 14-22
        • Taylor A.J.
        • Kent S.M.
        • Flaherty P.J.
        • et al.
        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
        • Pitt B.
        • Byington R.P.
        • Furberg C.D.
        • et al.
        Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events.
        Circulation. 2000; 102: 1503-1510
        • Lonn E.
        • Yusuf S.
        • Dzavik V.
        • et al.
        Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE).
        Circulation. 2001; 103: 919-925
        • Wildman R.P.
        • Schott L.L.
        • Brockwell S.
        • Kuller L.H.
        • Sutton-Tyrrell K.
        A dietary and exercise intervention slows menopause-associated progression of subclinical atherosclerosis as measured by intima-media thickness of the carotid arteries.
        J Am Coll Cardiol. 2004; 44: 579-585
        • Miller W.L.
        • Hartman K.A.
        • Burritt M.F.
        • et al.
        Serial biomarker measurements in ambulatory patients with chronic heart failure: the importance of change over time.
        Circulation. 2007; 116: 249-257
        • Kitta Y.
        • Obata J.E.
        • Nakamura T.
        • et al.
        Persistent impairment of endothelial vasomotor function has a negative impact on outcome in patients with coronary artery disease.
        J Am Coll Cardiol. 2009; 53: 323-330
        • Hernandez T.L.
        • Capell W.H.
        • Wolfe P.
        • Gerard L.A.
        • Eckel R.H.
        Time course of C-reactive protein reduction with simvastatin therapy in patients with type 2 diabetes mellitus.
        Am J Cardiol. 2006; 98: 1656-1659
        • Bertges D.J.
        • Muluk V.
        • Whittle J.
        • et al.
        Relevance of carotid stenosis progression as a predictor of ischemic neurological outcomes.
        Arch Intern Med. 2003; 163: 2285-2289
        • Lewis R.F.
        • Abrahamowicz M.
        • Côté R.
        • Battista R.N.
        Predictive power of duplex ultrasonography in asymptomatic carotid disease.
        Ann Intern Med. 1997; 127: 13-20
        • Finn A.V.
        • Kolodgie F.D.
        • Virmani R.
        Correlation between carotid intimal/medial thickness and atherosclerosis: a point of view from pathology.
        Arterioscler Thromb Vasc Biol. 2010; 30: 177-181
        • Adams M.R.
        • Nakagomi A.
        • Keech A.
        • et al.
        Carotid intimal-media thickness is only weakly correlated with the extent and severity of coronary artery disease.
        Circulation. 1995; 92: 2127-2134
        • Hirano M.
        • Nakamura T.
        • Kitta Y.
        • et al.
        Assessment of carotid plaque echolucency in addition to plaque size increases the predictive value of carotid ultrasound for coronary events in patients with coronary artery disease and mild carotid atherosclerosis.
        Atherosclerosis. 2010; 211: 451-455
        • Takiuchi S.
        • Kamide K.
        • Miwa Y.
        • et al.
        Diagnostic value of carotid intima-media thickness and plaque score for predicting target organ damage in patients with essential hypertension.
        J Hum Hypertens. 2004; 18: 17-23
        • Spence J.D.
        • Eliasziw M.
        • DiCicco M.
        • et al.
        Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy.
        Stroke. 2002; 33: 2916-2922
        • Spence J.D.
        Ultrasound measurement of carotid plaque as a surrogate outcome for coronary artery disease.
        Am J Cardiol. 2002; 89: 10B-15B
        • Gibbons R.J.
        • Abrams J.
        • Chatterjee K.
        • et al.
        ACC/AHA 2002 guideline update for the management of patients with chronic stable angina—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).
        J Am Coll Cardiol. 2003; 41: 159-168
        • Smith Jr., S.C.
        • Blair S.N.
        • Bonow R.O.
        • et al.
        AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology.
        J Am Coll Cardiol. 2001; 38: 1581-1583
        • The Examination Committee of Criteria for “Obesity Disease” in Japan, Japan Society for the Study of Obesity
        New criteria for “obesity disease” in Japan.
        Circ J. 2002; 66: 987-992
        • D’Agostino Sr., R.B.
        • Grundy S.
        • Sullivan L.M.
        • Wilson P.
        • CHD Risk Prediction Group
        Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation.
        JAMA. 2001; 286: 180-187
        • Kaski J.C.
        • Chester M.R.
        • Chen L.
        • Katritsis D.
        Rapid angiographic progression of coronary artery disease in patients with angina pectoris. The role of complex stenosis morphology.
        Circulation. 1995; 92: 2058-2065
        • Desbien A.M.
        • Chonchol M.
        • Gnahn H.
        • Sander D.
        Kidney function and progression of carotid intima-media thickness in a community study.
        Am J Kidney Dis. 2008; 51: 584-593
        • Solberg L.A.
        • Eggen D.A.
        Localization and sequence of development of atherosclerotic lesions in the carotid and vertebral arteries.
        Circulation. 1971; 43: 711-724