Skip to main content
SpringerLink
Log in

Use of Carotid Intima-Media Thickness Regression to Guide Therapy and Management of Cardiac Risks

  • Coronary Artery Disease (PH Stone, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Although carotid intima-media thickness (IMT) has been broadly used as a tool to evaluate cardiovascular risk, its role as a surrogate endpoint is still debated. The main issue is the fact that no study has ever been powered to show a relationship between changes in carotid IMT during follow-up and cardiovascular events. A meta-analysis of existing clinical studies was performed to investigate this relationship but it failed to demonstrate a predictive role of regression in carotid IMT for cardiovascular events. The reasons for the lack of a clear evidence for a predictive role of IMT progression are unknown but are likely multifactorial. Firstly, it may depend on the fact that this index is not a pure atherosclerosis index. Second, carotid atherosclerosis does not always reflect coronary atherosclerosis. Furthermore, methodologic problems related to intra- and interobserver variability make this index not adequately reproducible when tracking the progression of carotid atherosclerosis. A further meta-analysis based on individual patient data, instead of published data, has been planned to better address the predictive role of IMT. Lastly, in the future, the variability of ultrasound measurements of carotid IMT are likely to be reduced by further development of automatic calculation of this index by magnetic resonance imaging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation. 1986;74:1399–406.

    Article  PubMed  CAS  Google Scholar 

  2. Poli A, Tremoli E, Colombo A, Sirtori M, Pignoli P, Paoletti R. Ultrasonographic measurement of the common carotid artery wall thickness in hypercholesterolemic patients: a new model for the quantitation and follow-up of preclinical atherosclerosis in living human subjects. Atherosclerosis. 1988;70:253–61.

    Article  PubMed  CAS  Google Scholar 

  3. O’Leary DH, Polak JF, Kronmal RA, et al. Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. Stroke. 1992;23:1752–60.

    Article  PubMed  Google Scholar 

  4. Mannami T, Konishi M, Baba S, Nishi N, Terao A. Prevalence of asymptomatic carotid atherosclerotic lesions detected by high-resolution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city: the Suita study. Stroke. 1997;28:518–25.

    Article  PubMed  CAS  Google Scholar 

  5. Bots ML, Breslau PJ, Briet E, et al. Cardiovascular determinants of carotid artery disease: the Rotterdam Elderly Study. Hypertension. 1992;19:717–20.

    PubMed  CAS  Google Scholar 

  6. Burke GL, Evans GW, Riley WA, et al. Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study. Stroke. 1995;26:386–91.

    Article  PubMed  CAS  Google Scholar 

  7. Allan PL, Mowbray PI, Lee AJ, Fowkes FG. Relationship between carotid intima-media thickness and symptomatic and asymptomatic peripheral arterial disease: the Edinburgh Artery Study. Stroke. 1997;28:348–53.

    Article  PubMed  CAS  Google Scholar 

  8. Blankenhorn DH, Selzer RH, Crawford DW, et al. Beneficial effects of colestipol-niacin therapy on the common carotid artery: two- and four-year reduction of intima-media thickness measured by ultrasound. Circulation. 1993;88:20–8.

    PubMed  CAS  Google Scholar 

  9. Furberg CD, Adams HP, Applegate WB, et al. Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Circulation. 1994;90:1679–87.

    PubMed  CAS  Google Scholar 

  10. Salonen JT, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb. 1991;11:1245–9.

    Article  PubMed  CAS  Google Scholar 

  11. Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation. 1997;96:1432–7.

    PubMed  CAS  Google Scholar 

  12. Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol. 1997;146:483–94.

    PubMed  CAS  Google Scholar 

  13. Hodis HN, Mack WJ, LaBree L, et al. The role of carotid artery intima-media thickness in predicting clinical coronary events. Ann Intern Med. 1998;128:262–9.

    PubMed  CAS  Google Scholar 

  14. O’Leary DH, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999;340:14.

    Article  PubMed  Google Scholar 

  15. Lorenz MW, Markus HS, Bots ML, et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007;115:459–67.

    Article  PubMed  Google Scholar 

  16. Hodis HN, Mack WJ, LaBree L, et al. Reduction in carotid arterial wall thickness using lovastatin and dietary therapy. A randomized, controlled clinical trial. Ann Intern Med. 1996;124:548–56.

    PubMed  CAS  Google Scholar 

  17. Held C, Hjemdahl P, Eriksson SV, et al. Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Eur Heart J. 2001;22:62–72.

    Article  PubMed  CAS  Google Scholar 

  18. Wang JG, Staessen JA, Li Y, et al. Carotid intima-media thickness and antihypertensive treatment: a meta-analysis of randomized controlled trials. Stroke. 2006;37:1933–40.

    Article  PubMed  CAS  Google Scholar 

  19. Kang S, Wu Y, Li X. Effects of statin therapy on the progression of carotid atherosclerosis: a systematic review and meta-analysis. Atherosclerosis. 2004;177:433–42.

    Article  PubMed  CAS  Google Scholar 

  20. Espeland MA, O’Leary DH, Terry JG, et al. Carotid intimal-media thickness as a surrogate for cardiovascular disease events in trials of HMG-CoA reductase inhibitors. Curr Contr Trials Cardiovasc Med. 2005;6:3.

    Article  Google Scholar 

  21. Costanzo P, Perrone-Filardi P, Vassallo E, et al. Does carotid intima-media thickness regression predict reduction of cardiovascular events? A meta-analysis of 41 randomized trials. J Am Coll Cardiol. 2010;56:2006–20.

    Article  PubMed  Google Scholar 

  22. Goldberger ZD, Valle JA, Dandekar VK, et al. Are changes in carotid intima-media thickness related to risk of nonfatal myocardial infarction? A critical review and meta-regression analysis. Am Heart J. 2010;160:701–14.

    Article  PubMed  Google Scholar 

  23. Mathiesen EB, Johnsen SH, Wilsgaard T, et al. Carotid Plaque Area and Intima-Media Thickness in Prediction of First-Ever Ischemic Stroke: A 10-Year Follow-Up of 6584 Men and Women: The Tromso Study. Stroke. 2011;42:972–8.

    Article  PubMed  Google Scholar 

  24. Bortel L. What does intima–media thickness tell us? J Hypertens. 2005;23:37–9.

    Article  PubMed  Google Scholar 

  25. Adams MR, Nakagomi A, Keech A, et al. Carotid intimamedia thickness is only weakly correlated with the extent and severity of coronary artery disease. Circulation. 1995;92:2127–34.

    PubMed  CAS  Google Scholar 

  26. Ebrahim S, Papacosta O, Whincup P, et al. Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women: the British Regional Heart Study. Stroke. 1999;30:841–50.

    Article  PubMed  CAS  Google Scholar 

  27. Barnett PA, Spence JD, Manuck SB, Jennings JR. Psychological stress and the progression of carotid artery disease. J Hypertens. 1997;15:49–55.

    Article  PubMed  CAS  Google Scholar 

  28. Spence JD, Eliasziw M, DiCicco M, et al. Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. Stroke. 2002;33:2916–22.

    Article  PubMed  Google Scholar 

  29. Johnsen SH, Mathiesen EB, Joakimsen O, et al. Carotid atherosclerosis is a stronger predictor of myocardial infarction in women than in men: a 6-year follow-up study of 226 persons: the Tromsø study. Stroke. 2007;38:2873–80.

    Article  PubMed  Google Scholar 

  30. Spence JD, Hegele RA. Noninvasive phenotypes of atherosclerosis: similar windows but different views. Stroke. 2004;35:649–53.

    Article  PubMed  Google Scholar 

  31. O’Leary DH, Polak JF, Kronmal RA, Cardiovascular Health Study Collaborative Research Group, et al. Thickening of the carotid wall: a marker for atherosclerosis in the elderly? Stroke. 1996;27:224–31.

    Article  PubMed  Google Scholar 

  32. Spence ID, Barnett PA, Bulman DE, Hegele RA. An approach to ascertain probands with a non traditional risk factor for carotid atherosclerosis. Atherosclerosis. 1999;144:429–43.

    Article  PubMed  CAS  Google Scholar 

  33. Finn AV, Kolodgie FD, Virmani R. Correlation between carotid intimal/medial thickness and atherosclerosis: a point of view from pathology. Arterioscler Thromb Vasc Biol. 2010;30:177–181.

    Google Scholar 

  34. Prentice RL. Surrogate endpoints in clinical trials: definition and operational criteria. Stat Med. 1989;8:431–40.

    Article  PubMed  CAS  Google Scholar 

  35. Pasterkamp G, Schoneveld AH, van Wolferen W, et al. The impact of atherosclerotic arterial remodeling on percentage of luminal stenosis varies widely within the arterial system. A post-mortem study. Arterioscler Thromb Vasc Biol. 1997;17:3057–63.

    Article  PubMed  CAS  Google Scholar 

  36. Holme I, Enger SC, Helgeland A, et al. Risk factors and raised atherosclerotic lesions in coronary and cerebral arteries. Statistical analysis from the Oslo study. Arteriosclerosis. 1981;1:250–6.

    Article  PubMed  CAS  Google Scholar 

  37. Sternby NH. Atherosclerosis in a defined population. An autopsy survey in Malmo, Sweden. Acta Pathol Microbiol Scand. 1968;(Suppl. 194):5–11.

  38. de Groot E, van Leuven SI, Duivenvoorden R, et al. Measurement of carotid intima-media thickness to assess progression and regression of atherosclerosis. Nat Clin Pract Cardiovasc Med. 2008;5:280–8.

    Article  PubMed  Google Scholar 

  39. Lorenz MW, Bickel H, Bots ML et al. PROG-IMT Study Group. Individual progression of carotid intima media thickness as a surrogate for vascular risk (PROG-IMT): Rationale and design of a meta-analysis project. Am Heart J. 2010;159:730–736.e2.

    Article  PubMed  Google Scholar 

  40. Boussel L, Serusclat A, Skilton MR, et al. The reliability of high resolution MRI in the measurement of early stage carotid wall thickening. J Cardiovasc Magn Reson. 2007;9:771–6.

    Article  PubMed  Google Scholar 

  41. Saam T, Ferguson MS, Yarnykh VL, et al. Quantitative evaluation of carotid plaque composition by in vivo MRI. Arterioscler Thromb Vasc Biol. 2005;25:234–9.

    Article  PubMed  CAS  Google Scholar 

  42. Pencina MJ, D’Agostino Sr RB, Steyerberg EW. Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med. 2011;30:11–21.

    Article  PubMed  Google Scholar 

  43. Duivenvoorden R, de Groot E, Elsen BM, et al. In vivo quantification of carotid artery wall dimensions: 3.0-Tesla MRI versus B-mode ultrasound imaging. Circ Cardiovasc Imag. 2009;2:235–42.

    Article  CAS  Google Scholar 

  44. Underhill HR, Kerwin WS, Hatsukami TS, Yuan C. Automated measurement of mean wall thickness in the common carotid artery by MRI: a comparison to intima-media thickness by B-mode ultrasound. J Magn Reson Imaging. 2006;24:379–87.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Immunological and Cardiovascular Science, Federico II University of Naples, Naples, Italy

    P. Costanzo MD, E. Vassallo MD & P. Perrone-Filardi MD, PhD

  2. Academic Cardiology Unit, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK

    P. Costanzo MD & J. G. Cleland MD, FRCP, FACC, FESC

  3. Unit of Endocrinology and Metabolism, Hull York Medical School, Hull, UK

    S. L. Atkin MD, PhD

Authors
  1. P. Costanzo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. G. Cleland MD, FRCP, FACC, FESC
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. L. Atkin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Vassallo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Perrone-Filardi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Costanzo MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Costanzo, P., Cleland, J.G., Atkin, S.L. et al. Use of Carotid Intima-Media Thickness Regression to Guide Therapy and Management of Cardiac Risks. Curr Treat Options Cardio Med 14, 50–56 (2012). https://doi.org/10.1007/s11936-011-0158-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-011-0158-1

Keywords

Search

Navigation