American Journal of Epidemiology Vol. 146, No. 6: 483-494
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
Association of Coronary Heart Disease Incidence with Carotid Arterial Wall Thickness and Major Risk Factors: The Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993
1Department of Biostatistics, School of Public Health, University of North Carolina Chapel Hill, NC
2Department of Epidemiology, School of Public Health, University of North Carolina Chapel Hill, NC
3Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis, MN
4Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University Baltimore, MD
5National Heart, Lung, and Blood Institute Bethesda, MD
Reprint requests to Dr. Lloyd E. Chambless, Department of Biostatistics, School of Public Health, University of North Carolina, Chapel Hill, NC 27514
Few studies have determined whether greater carotid artery intima-media thickness (IMT) in asymptomatic individuals is associated prospectively with increased risk of coronary heart disease (CHD). In the Atherosclerosis Risk in Communities Study, carotid IMT, an index of generalized atherosclerosis, was defined as the mean of MT measurements at six sites of the carotid arteries using B-mode ultrasound. The authors assessed its relation to CHD incidence over 4–7 years of follow-up (1987–1993) in four US communities (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland) from samples of 7,289 women and 5,552 men aged 45–64 years who were free of clinical CHD at baseline. There were 96 incident events for women and 194 for men. In sex-specific Cox proportional hazards models adjusted only for age, race, and center, the hazard rate ratio comparing extreme mean IMT (
1 mm) to not extreme (<1 mm) was 5.07 for women (95% confidence interval 3.08–8.36) and 1.85 for men (95% confidence interval 1.28–2.69). The relation was graded (monotonic), and models with cubic splines indicated significant nonlinearity. The strength of the association was reduced by including major CHD risk factors, but remained elevated at higher IMT. Up to 1 mm mean IMT, women had lower adjusted annual event rates than did men, but above 1 mm their event rate was closer to that of men. Thus, mean carotid IMT is a noninvasive predictor of future CHD incidence. Am J Epidemiol 1997;146:483-94.
carotid arteries; coronary disease; incidence; risk factors; ultrasonography
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