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(Stroke. 2008;39:2958.)
© 2008 American Heart Association, Inc.

Original Contributions

Calf Circumference Is Inversely Associated With Carotid Plaques

Stéphanie Debette, MD; Nathalie Leone, MD; Dominique Courbon, PhD; Jérôme Gariépy, MD; Christophe Tzourio, MD, PhD; Jean-François Dartigues, MD; Karen Ritchie, MD, PhD; Annick Alpérovitch, MD; Pierre Ducimetière, PhD; Philippe Amouyel, MD, PhD Mahmoud Zureik, MD, PhD

From Inserm, U744 (S.D., N.L., D.C., P.A., M.Z.), Lille, France; the Department of Neurology (EA2691) (S.D.), University Hospital of Lille, Lille, France; Inserm, U700 (N.L., D.C., M.Z.), Paris, France; Inserm, U708 (C.T., A.A.), Paris, France; Inserm, U593 (J.F.D.), Bordeaux, France; Inserm, E0361 (K.R.), Montpellier, France; Inserm, U780 (P.D.), Paris, France; and Centre de Médecine Préventive Cardiovasculaire (J.G.), Broussais Hospital, Paris, France.

Correspondence to Mahmoud Zureik, MD, PhD, Inserm, U700, Faculté de Médecine de Xavier Bichat, 16 Rue Henri Huchard, Paris, F-75018, France. E-mail mahmoud.zureik{at}inserm.fr

Background and Purpose— The association of carotid atherosclerosis with body composition and fat distribution is poorly understood. We aimed to test the cross-sectional association of carotid plaques and common carotid artery intima-media thickness with calf circumference (CC), representing peripheral fat and lean mass, and with waist circumference and waist-to-hip ratio, 2 markers of abdominal obesity.

Methods— The study was performed on 6265 subjects aged 65 years recruited prospectively from the electoral rolls of 3 French cities. Ultrasound examination and anthropometric measures were performed according to a standardized protocol.

Results— Carotid plaques were less frequent with increasing CC, the ORs for the second, third, and fourth quartile of CC compared with the first quartile being 0.98 (95% CI, 0.84 to 1.15), 0.85 (95% CI, 0.72 to 1.01), and 0.71 (95% CI,:0.58 to 0.86; P for trend=0.0002), respectively, independently of age, gender, body mass index, and other vascular risk factors. There was an opposite and multiplicative effect of CC and waist-to-hip ratio on the frequency of carotid plaques (55.1% of individuals in the fourth waist-to-hip ratio quartile and the first CC quartile had carotid plaques, against 31.8% in the first waist-to-hip ratio and the fourth CC quartile). Mean common carotid artery intima-media thickness was larger with increasing waist circumference, waist-to-hip ratio, and CC, but the association with CC disappeared after adjusting for body mass index.

Conclusion— The present study shows, for the first time, an inverse relationship between carotid plaques and CC. Although this needs to be confirmed in other populations, it may suggest an antiatherogenic effect of large CC.

Key Words: atherosclerosis • carotid artery • carotid intimal medial thickness • epidemiology • ultrasound