American Journal of Epidemiology Vol. 151, No. 5: 478-487
Copyright © 2000 by The Johns Hopkins University School of Hygiene and Public Health
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Carotid Wall Thickness is Predictive of Incident Clinical Stroke: The Atherosclerosis Risk in Communities (ARIC) Study
1Department of Biostatistics, School of Public Health, University of North Carolina Chapel Hill, NC
2Division of Epidemiology, School of Public Health, University of Minnesota Minneapolis, MN
3National Cancer Institute Bethesda, MD
4National Heart, Lung, and Blood Institute Bethesda, MD
5Division of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University Baltimore, MD
6Division of Epidemiology, School of Public Health, University of North Carolina Chapel Hill, NC
7Department of Public Health, Bowman Gray School of Medicine Winston-Salem, NC
Reprint requests to Dr. Lloyd E. Chambless, Department of Biostatistics, University of North Carolina School of Public Health, Chapel Hill, NC 27514.
Few studies have determined whether carotid artery intima-media thickness (IMT) is associated prospectively with risk of first ischemic stroke. In the Atherosclerosis Risk in Communities Study, carotid IMT, an index of generalized atherosclerosis, was defined as the mean of IMT measured by B-mode ultrasonography at six sites of the carotid arteries. The authors assessed the relation of mean IMT to stroke incidence over 6–9 years' follow-up (1987–1995) among 7,865 women and 6,349 men aged 45–64 years without prior stroke at baseline in four US communities. There were 90 incident ischemic stroke events for women and 109 for men. In sex-specific Cox proportional hazards models adjusting only for age, race, and community, the hazard rate ratios comparing extreme mean IMT values (
1 mm) to values less than 0.6 mm were 8.5 for women (95% confidence interval: 3.5, 20.7) and 3.6 for men (95% confidence interval: 1.5, 9.2). The relation was graded, and models with cubic splines indicated significant nonlinearity, with hazards increasing more rapidly at lower IMTs than at higher IMTs. Thus, models using linear IMT values substantially underestimate the strength of the association at lower IMTs. The strength of the association was reduced by the inclusion of putative stroke risk factors, but it remained elevated at higher IMTs. Hence, mean carotid IMT is a noninvasive predictor of future ischemic stroke incidence. Am J Epidemiol 2000;151:478–87.
carotid arteries; cerebrovascular disorders; incidence; risk factors; ultrasonography
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J. D. Barth, A. Iglesias del Sol, D. E. Grobbee, J. C.M. Witteman, and M. L. Bots IMT for the Elderly? Stroke, October 1, 2001; 32(10): 2443 - 2445. [Full Text] [PDF]
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K. J. Hunt, G. W. Evans, A. R. Folsom, A. R. Sharrett, L. E. Chambless, C. H. Tegeler, and G. Heiss Acoustic Shadowing on B-Mode Ultrasound of the Carotid Artery Predicts Ischemic Stroke : The Atherosclerosis Risk in Communities (ARIC) Study Stroke, May 1, 2001; 32(5): 1120 - 1126. [Abstract] [Full Text] [PDF]
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E. O. Talbott, D. S. Guzick, K. Sutton-Tyrrell, K. P. McHugh-Pemu, J. V. Zborowski, K. E. Remsberg, and L. H. Kuller Evidence for Association Between Polycystic Ovary Syndrome and Premature Carotid Atherosclerosis in Middle-Aged Women Arterioscler Thromb Vasc Biol, November 1, 2000; 20(11): 2414 - 2421. [Abstract] [Full Text] [PDF]
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M. L. Eigenbrodt, K. M. Rose, D. J. Couper, D. K. Arnett, R. Smith, and D. Jones Orthostatic Hypotension as a Risk Factor for Stroke : The Atherosclerosis Risk in Communities (ARIC) Study, 1987-1996 Stroke, October 1, 2000; 31(10): 2307 - 2313. [Abstract] [Full Text] [PDF]
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H. Tanaka, F. A. Dinenno, D. R. Seals, L. Kornet, R. S. Reneman, and A. P. G. Hoeks Age-Related Increase in Femoral Intima-Media Thickness in Healthy Humans Arterioscler Thromb Vasc Biol, September 1, 2000; 20(9): 2172 - 2172. [Full Text] [PDF]
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C. Yuan, L. M. Mitsumori, K. W. Beach, and K. R. Maravilla Carotid Atherosclerotic Plaque: Noninvasive MR Characterization and Identification of Vulnerable Lesions Radiology, November 1, 2001; 221(2): 285 - 299. [Abstract] [Full Text] [PDF]
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