Carotid-Artery Intima and Media Thickness as a Risk Factor for Myocardial Infarction and Stroke in Older Adults

O'Leary, Daniel H.; Polak, Joseph F.; Kronmal, Richard A.; Manolio, Teri A.; Burke, Gregory L.; Wolfson, Sidney K.

doi:10.1056/nejm199901073400103

Cited by 4,685Cardiovascular Health and Disease PreventionCerebrovascular and Carotid Artery DiseasesDiabetes, Cardiovascular Risks, and Lipoproteins

Carotid-Artery Intima and Media Thickness as a Risk Factor for Myocardial Infarction and Stroke in Older Adults

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O'Leary, Daniel H., Polak, Joseph F., Kronmal, Richard A., Manolio, Teri A., Burke, Gregory L., Wolfson, Sidney K.·1999·New England Journal of Medicine

DOI 10.1056/nejm199901073400103

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Abstract

BACKGROUND: The combined thickness of the intima and media of the carotid artery is associated with the prevalence of cardiovascular disease. We studied the associations between the thickness of the carotid-artery intima and media and the incidence of new myocardial infarction or stroke in persons without clinical cardiovascular disease. METHODS: Noninvasive measurements of the intima and media of the common and internal carotid artery were made with high-resolution ultrasonography in 5858 subjects 65 years of age or older. Cardiovascular events (new myocardial infarction or stroke) served as outcome variables in subjects without clinical cardiovascular disease (4476 subjects) over a median follow-up period of 6.2 years. RESULTS: The incidence of cardiovascular events correlated with measurements of carotid-artery intima-media thickness. The relative risk of myocardial infarction or stroke increased with intima-media thickness (P<0.001). The relative risk of myocardial infarction or stroke (adjusted for age and sex) for the quintile with the highest thickness as compared with the lowest quintile was 3.87 (95 percent confidence interval, 2.72 to 5.51). The association between cardiovascular events and intima-media thickness remained significant after adjustment for traditional risk factors, showing increasing risks for each quintile of combined intima-media thickness, from the second quintile (relative risk, 1.54; 95 percent confidence interval, 1.04 to 2.28), to the third (relative risk, 1.84; 95 percent confidence interval, 1.26 to 2.67), fourth (relative risk, 2.01; 95 percent confidence interval, 1.38 to 2.91), and fifth (relative risk, 3.15; 95 percent confidence interval, 2.19 to 4.52). The results of separate analyses of myocardial infarction and stroke paralleled those for the combined end point. CONCLUSIONS: Increases in the thickness of the intima and media of the carotid artery, as measured noninvasively by ultrasonography, are directly associated with an increased risk of myocardial infarction and stroke in older adults without a history of cardiovascular disease.

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Population-based studies show a correlation between the severity of atherosclerosis in one arterial territory and the involvement of other arteries.
“Population-based studies have shown a correlation between the severity of atherosclerosis in one arterial territory and the involvement of other arteries.130”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [130]
The relative risk for events is slightly lower after statistical correction for traditional risk factors, but the risk remains elevated at higher IMT.
“Although the relative risk for events is slightly lower after statistical correction for the presence of traditional risk factors, the risk remains elevated at higher IMT.130”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [130]
When IMT is used to predict incidence of subsequent stroke, the risk is graded but non-linear, with hazards increasing more rapidly at lower IMTs than at higher IMTs.
“When IMT is used to predict the incidence of subsequent stroke, the risk is graded but non-linear, with hazards increasing more rapidly at lower IMTs than at higher IMTs.130”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [130]
IMT is used to reflect the degree of systemic arteriosclerosis or as an alternative assessment factor for predicting the risk of co-existence or onset of ASCVD (e.g., CAD, PAD, cerebrovascular diseases).
“It is also used to reflect the degree of systemic arteriosclerosis or as an alternative assessment factor for predicting the risk of co-existence or onset of ASCVD (e.g., CAD, PAD, cerebrovascular diseases, etc.)5–8).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [6]
Findings of arteriosclerosis in the carotid arteries are an independent risk factor for CVD.
“In addition, findings of arteriosclerosis in the carotid arteries are an independent risk factor for CVD6, 8).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [6]

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Original Article Increased Intima-Media Thickness is Independently Associated with Ischemic Stroke
Freitas, D., Alves, A., Pereira, R., Pereira, T., & Cardiol, B. (2011)

Authors: O'Leary, D. H., Polak, J. F., Kronmal, R. A., Manolio, T. A., Burke, G. L., & Wolfson, S. K.
Affiliations: Brigham and Women's Hospital (US)
University of Washington (US)
National Heart, Lung, and Blood Institute (US)
Atrium Health Wake Forest Baptist (US)
ORCID: Polak, Joseph F.
Kronmal, Richard A.
Manolio, Teri A.
Burke, Gregory L.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1999-01-07
Volume: 340
Issue: 1
Pages: 14-22
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199901073400103
OpenAlex: W2316167515
Cited by: 4,685
References: 40
Citations by year: 2026: 33 · 2025: 66 · 2024: 61 · 2023: 77 · 2022: 84 · 2021: 103 · 2020: 123 · 2019: 130 · 2018: 149 · 2017: 150 · 2016: 177 · 2015: 210 · 2014: 191 · 2013: 251 · 2012: 231
FWCI: 99.83
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (n01hc085081-021, n01hc085079-024, n01hc085080-026)
National Heart, Lung, and Blood Institute (N01-HC-85081, N01HC85080, N01-HC85079)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: carotid intima-media thickness, myocardial infarction, stroke, cardiovascular risk factors, older adults, carotid artery, atherosclerosis, high-resolution ultrasound
MeSH terms: Aged, Carotid Arteries, Cerebrovascular Disorders, Female, Humans, Male, Myocardial Infarction, Prospective Studies, Risk Factors, Ultrasonography, Incidence, Proportional Hazards Models, Tunica Intima, Tunica Media, Disease-Free Survival

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Carotid-Artery Intima and Media Thickness as a Risk Factor for Myocardial Infarction and Stroke in Older Adults

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