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(Stroke. 2004;35:2150.)
© 2004 American Heart Association, Inc.

Original Contributions

Rates and Determinants of Site-Specific Progression of Carotid Artery Intima-Media Thickness

The Carotid Atherosclerosis Progression Study

Andrew D. Mackinnon, MRCP; Paula Jerrard-Dunne, MRCPI; Matthias Sitzer, MD; Alexandra Buehler, MD; Stefan von Kegler, MD Hugh S. Markus, FRCP

From the Department of Clinical Neurosciences (A.D.M., P.J.-D., H.S.M.), St. George’s Hospital Medical School, London, UK; and the Department of Neurology (M.S., A.B., S.v.K.), Johann Wolfgang Goethe University, Frankfurt am Main, Germany.

Correspondence to Prof Hugh Markus, Department of Clinical Neurosciences, St. George’s Hospital Medical School, Cranmer Terrace, Tooting, London SW17 0RE, United Kingdom. E-mail hmarkus{at}sghms.ac.uk

Background and Purpose— Carotid intima-media thickness (IMT) progression rates are increasingly used as an intermediate outcome for vascular risk. The carotid bifurcation (BIF) and internal carotid artery (ICA) are predilection sites for atherosclerosis. IMT measures from these sites may be a better estimate of atherosclerosis than common carotid artery (CCA) IMT. The study aim was to evaluate site-specific IMT progression rates and their relationships to vascular risk factors compared with baseline IMT measurements.

Methods— In a community population (n=3383), ICA-IMT, BIF-IMT, CCA-IMT, and vascular risk factors were evaluated at baseline and at 3-year follow-up.

Results— Mean (SD) IMT progression was significantly greater at the ICA (0.032 [0.109] mm/year) compared with the BIF (0.023 [0.108] mm/year) and the CCA (0.001 [0.040] mm/year) (P<0.001). Only ICA-IMT progression significantly correlated with baseline vascular risk factors (age, male gender, hypertension, diabetes, and smoking). Change in risk factor profile over follow-up, estimated using the Framingham risk score, was a predictor of IMT progression only. For all arterial sites, correlations were stronger, by a factor of 2 to 3, for associations with baseline IMT compared with IMT progression.

Conclusions— Progression rates at the ICA rather than the CCA yield greater absolute changes in IMT and better correlations with vascular risk factors. Vascular risk factors correlate more strongly with baseline IMT than with IMT progression. Prospective data on IMT progression and incident vascular events are required to establish the true value of progression data as a surrogate measure of vascular risk.

Key Words: atherosclerosis • carotid arteries • disease progression • ultrasonography

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