Published online before print September 4, 2003, doi: 10.1161/01.STR.0000091393.32060.0E
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2003;34:2367.)
© 2003 American Heart Association, Inc.
Original Contributions |
Comparison Between Measures of Atherosclerosis and Risk of Stroke
The Rotterdam Study
From the Department of Epidemiology and Biostatistics (M.H., A.E.H., A.H., J.C.M.W., M.M.B.B.) and Department of Neurology (M.H., P.J.K.), Erasmus Medical Center, Rotterdam, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (M.L.B., D.E.G.), the Netherlands.
Correspondence to Monique M.B. Breteler, MD, PhD, Department of Epidemiology and Biostatistics, Erasmus Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands. E-mail m.breteler{at}erasmusmc.nl
Background and Purpose— Several measures of atherosclerosis predict the risk of stroke. However, a comparison between various measures of atherosclerosis is lacking, and limited information exists on the added value of individual measures of atherosclerosis to cardiovascular risk factors. We compared different measures of atherosclerosis in relation to stroke.
Methods— The study was based on the prospective cohort of the Rotterdam Study and included 6913 participants who did not suffer from previous stroke. At baseline, carotid intima-media thickness and plaques, ankle-arm index, and aortic calcifications were assessed; 3996 participants (53%) had measures of all studied markers of atherosclerosis. After a mean follow-up of 6.1 years, 378 strokes occurred. Data were analyzed with Cox proportional-hazards regression and Akaike information criteria scores.
Results— Carotid intima-media thickness and aortic calcifications were related most strongly to the risk of stroke (relative risk, 2.23 and 1.89; 95% confidence interval, 1.48 to 3.36 and 1.28 to 2.80 for highest versus lowest tertile, respectively). The relations between intima-media thickness, aortic calcifications, and carotid plaques and stroke remained after adjustment for cardiovascular risk factors. Intima-media thickness and aortic calcifications were related to the risk of stroke independently of each other. The relation between ankle-arm index and stroke disappeared after adjustment for cardiovascular risk factors.
Conclusions— Carotid intima-media thickness and aortic calcifications are stronger predictors of incident stroke than carotid plaque or ankle-arm indexes. They have additional value to each other and to classic risk factors and may reflect different processes.
Key Words: atherosclerosis • epidemiology • risk factors
This article has been cited by other articles:
 |
|
 |
|
  K. A Deans, V. Bezlyak, I. Ford, G D. Batty, H. Burns, J. Cavanagh, E. d. Groot, A. McGinty, K. Millar, P. G Shiels, et al. Differences in atherosclerosis according to area level socioeconomic deprivation: cross sectional, population based study BMJ, October 27, 2009; 339(oct27_4): b4170 - b4170. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. C. Gallo, K. E. de los Monteros, M. Allison, A. D. Roux, J. F. Polak, K. E. Watson, and L. S. Morales Do Socioeconomic Gradients in Subclinical Atherosclerosis Vary According to Acculturation Level? Analyses of Mexican-Americans in the Multi-Ethnic Study of Atherosclerosis Psychosom Med, September 1, 2009; 71(7): 756 - 762. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hyvarinen, J. Tuomilehto, M. Mahonen, C. D. Stehouwer, K. Pyorala, B. Zethelius, Q. Qiao, and for the DECODE Study Group Hyperglycemia and Incidence of Ischemic and Hemorrhagic Stroke-Comparison Between Fasting and 2-Hour Glucose Criteria Stroke, May 1, 2009; 40(5): 1633 - 1637. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. D. Wong, H. Gransar, L. Shaw, D. Polk, J. H. Moon, R. Miranda-Peats, S. W. Hayes, L. E.J. Thomson, A. Rozanski, J. D. Friedman, et al. Thoracic aortic calcium versus coronary artery calcium for the prediction of coronary heart disease and cardiovascular disease events. J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 319 - 326. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. D. Toussaint, K. K. Lau, B. J. Strauss, K. R. Polkinghorne, and P. G. Kerr Determination and Validation of Aortic Calcification Measurement from Lateral Bone Densitometry in Dialysis Patients Clin. J. Am. Soc. Nephrol., January 1, 2009; 4(1): 119 - 127. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Gonzalez, J. C. Wood, F. J. Dorey, T. A. L. Wren, and V. Gilsanz Reproducibility of Carotid Intima-Media Thickness Measurements in Young Adults Radiology, May 1, 2008; 247(2): 465 - 471. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M J E van Rijn, M J Bos, A Isaacs, M Yazdanpanah, A Arias-Vasquez, B H C. Stricker, O H Klungel, B A Oostra, P J Koudstaal, J C Witteman, et al. Polymorphisms of the renin angiotensin system are associated with blood pressure, atherosclerosis and cerebral white matter pathology J. Neurol. Neurosurg. Psychiatry, October 1, 2007; 78(10): 1083 - 1087. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Poredos and B. Jug The Prevalence of Peripheral Arterial Disease in High Risk Subjects and Coronary or Cerebrovascular Patients Angiology, July 1, 2007; 58(3): 309 - 315. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Mupparapu and I. H. Kim Calcified carotid artery atheroma and stroke: A systematic review J Am Dent Assoc, April 1, 2007; 138(4): 483 - 492. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Hansen, J. Wikstrom, L.O. Johansson, L. Lind, and H. Ahlstrom The Prevalence and Quantification of Atherosclerosis in an Elderly Population Assessed by Whole-Body Magnetic Resonance Angiography Arterioscler Thromb Vasc Biol, March 1, 2007; 27(3): 649 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. W. Lorenz, H. S. Markus, M. L. Bots, M. Rosvall, and M. Sitzer Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis Circulation, January 30, 2007; 115(4): 459 - 467. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. E. van Rijn, M. J. Bos, M. Yazdanpanah, A. Isaacs, A. Arias-Vasquez, P. J. Koudstaal, A. Hofman, J. C. Witteman, C. M. van Duijn, and M. M. B. Breteler {alpha}-Adducin Polymorphism, Atherosclerosis, and Cardiovascular and Cerebrovascular Risk Stroke, December 1, 2006; 37(12): 2930 - 2934. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Ikram, M. Hollander, M. J. Bos, J. A. Kors, P. J. Koudstaal, A. Hofman, J.C.M. Witteman, and M. M.B. Breteler Unrecognized myocardial infarction and the risk of stroke: the Rotterdam Study. Neurology, November 14, 2006; 67(9): 1635 - 1639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. S. Nam, S. W. Han, J. Y. Lee, S. H. Ahn, J. W. Ha, S. J. Rim, B. I. Lee, and J. H. Heo Association of aortic plaque with intracranial atherosclerosis in patients with stroke. Neurology, October 10, 2006; 67(7): 1184 - 1188. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Dijk, Y. van der Graaf, M. L. Bots, D. E. Grobbee, A. Algra, and on behalf of the SMART study group Carotid intima-media thickness and the risk of new vascular events in patients with manifest atherosclerotic disease: the SMART study Eur. Heart J., August 2, 2006; 27(16): 1971 - 1978. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Staub, A. Meyerhans, B. Bundi, H. P. Schmid, and B. Frauchiger Prediction of Cardiovascular Morbidity and Mortality: Comparison of the Internal Carotid Artery Resistive Index With the Common Carotid Artery Intima-Media Thickness Stroke, March 1, 2006; 37(3): 800 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N.F. Fanning, T.D. Walters, A.J. Fox, and S.P. Symons Association between Calcification of the Cervical Carotid Artery Bifurcation and White Matter Ischemia. AJNR Am. J. Neuroradiol., February 1, 2006; 27(2): 378 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Sander, C. Schulze-Horn, H. Bickel, H. Gnahn, E. Bartels, and B. Conrad Combined Effects of Hemoglobin A1c and C-Reactive Protein on the Progression of Subclinical Carotid Atherosclerosis: The INVADE Study Stroke, February 1, 2006; 37(2): 351 - 357. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. W. Lorenz, S. von Kegler, H. Steinmetz, H. S. Markus, and M. Sitzer Carotid Intima-Media Thickening Indicates a Higher Vascular Risk Across a Wide Age Range: Prospective Data From the Carotid Atherosclerosis Progression Study (CAPS) Stroke, January 1, 2006; 37(1): 87 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Harloff, M Handke, A Geibel, E Oehm, B Guschlbauer, M Olschewski, and A Hetzel Do stroke patients with normal carotid arteries require TEE for exclusion of relevant aortic plaques? J. Neurol. Neurosurg. Psychiatry, December 1, 2005; 76(12): 1654 - 1658. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Nighoghossian, L. Derex, and P. Douek The Vulnerable Carotid Artery Plaque: Current Imaging Methods and New Perspectives Stroke, December 1, 2005; 36(12): 2764 - 2772. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Elbaz, M. Ripert, B. Tavernier, B. Fevrier, M. Zureik, J. Gariepy, A. Alperovitch, and C. Tzourio Common Carotid Artery Intima-Media Thickness, Carotid Plaques, and Walking Speed Stroke, October 1, 2005; 36(10): 2198 - 2202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kitamura, H. Iso, H. Imano, T. Ohira, T. Okada, S. Sato, M. Kiyama, T. Tanigawa, K. Yamagishi, and T. Shimamoto Carotid Intima-Media Thickness and Plaque Characteristics as a Risk Factor for Stroke in Japanese Elderly Men Stroke, December 1, 2004; 35(12): 2788 - 2794. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Spence and M. L. Bots Ultrasound Measurement of Atherosclerosis * Response: Carotid Intima-Media Thickness Measurements in Intervention Studies Stroke, May 1, 2004; 35(5): e87 - e88. [Full Text] [PDF]
|
|
|
|
|
|
L. E. Wagenknecht, C. D. Langefeld, J. J. Carr, W. Riley, B. I. Freedman, S. Moossavi, and D. W. Bowden Race-Specific Relationships Between Coronary and Carotid Artery Calcification and Carotid Intimal Medial Thickness Stroke, May 1, 2004; 35(5): e97 - e99. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. F. Meschia and T. C. Gerber Editorial Comment--Vascular Thickness and Calcification as Markers of Atherosclerotic Burden Stroke, October 1, 2003; 34(10): 2372 - 2373. [Full Text] [PDF]
|
|