Carotid Atherosclerosis Is a Stronger Predictor of Myocardial Infarction in Women Than in Men: A 6-Year Follow-Up Study of 6226 Persons: The Tromso Study

Department of Neurology, University Hospital North-Norway, N-9038 Tromsø, Norway.
Stroke (Impact Factor: 5.72). 12/2007; 38(11):2873-80. DOI: 10.1161/STROKEAHA.107.487264
Source: PubMed


Ultrasound of carotid arteries provides measures of intima media thickness (IMT) and plaque, both widely used as surrogate measures of cardiovascular disease. Although IMT and plaques are highly intercorrelated, the relationship between carotid plaque and IMT and cardiovascular disease has been conflicting. In this prospective, population-based study, we measured carotid IMT, total plaque area, and plaque echogenicity as predictors for first-ever myocardial infarction (MI).
IMT, total plaque area, and plaque echogenicity were measured in 6226 men and women aged 25 to 84 years with no previous MI. The subjects were followed for 6 years and incident MI was registered.
During follow-up, MI occurred in 6.6% of men and 3.0% of women. The adjusted relative risk (RR; 95% CI) between the highest plaque area tertile versus no plaque was 1.56 (1.04 to 2.36) in men and 3.95 (2.16 to 7.19) in women. In women, there was a significant trend toward a higher MI risk with more echolucent plaque. The adjusted RR (95% CI) in the highest versus lowest IMT quartile was 1.73 (0.98 to 3.06) in men and 2.86 (1.07 to 7.65) in women. When we excluded bulb IMT from analyses, IMT did not predict MI in either sex.
In a general population, carotid plaque area was a stronger predictor of first-ever MI than was IMT. Carotid atherosclerosis was a stronger risk factor for MI in women than in men. In women, the risk of MI increased with plaque echolucency.

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    • "However, compared to cIMT, carotid plaque is a more reliable indicator of severe atherosclerosis [28] [29] [30] [31] [32] [33] [34]. Thus, cIMT reflects mostly arterial media thickening in response to aging and elevated blood pressure whereas plaque represents intimal pathology and advanced atherosclerosis that links more closely to coronary heart disease risk factors and myocardial infarction [28] [29] [30] [31] [32] [33] [34]. "
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    ABSTRACT: In the present study, we examined the potential impact of adiponectin on carotid ultrasound determined atherosclerosis in 210 (119 black and 91 white) RA patients in mixed regression models. Total adiponectin concentrations were smaller in patients with compared to those without the metabolic syndrome (MetS) defined waist criterion (median (range) = 6.47 (1.23-34.54) versus 8.38 (0.82-85.30) ng/mL, P = 0.02, resp.); both total and high molecular weight (HMW) adiponectin concentrations were larger in patients with compared to those without joint deformities (7.97 (0.82-85.30) and 3.51 (0.01-35.40) versus 5.36 (1.29-19.49) and 2.34 (0.01-19.49) ng/mL, P = 0.003 and 0.02, resp.). Total and HMW adiponectin concentrations were associated with carotid artery plaque in patients with MetS waist (odds ratio (95% CI) = 0.87 (0.76-0.99) and 0.92 (0.85-0.99) per 1-standard deviation increment, P = 0.02 for both) and those without joint deformities (odds ratio (95% CI) = 0.94 (0.88-0.99) and 0.94 (0.89-0.99), P = 0.03 for both). Plaque prevalence was lower in patients without compared to those with joint deformities (23.4% versus 42.6, P = 0.004 in multivariable analysis). In RA patients with abdominal obesity or no clinically evident joint damage, adiponectin concentrations are reduced but nevertheless associated with decreased carotid atherosclerosis.
    Full-text · Article · Jun 2014 · Mediators of Inflammation
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    • "However, increases in IMT and plaque formation are biologically distinct and may reflect different features of atherosclerosis. IMT, which primarily reflects an adaptive hypertrophic response of the media, is regarded as an indicator of early atherosclerosis, whereas plaque, which is a pathological deposit on the intima, primarily represents a later stage of atherosclerosis.18,28,29 "
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    ABSTRACT: Background We investigated the relation of self-reported snoring with carotid intima-media thickness (IMT) and plaque in community-dwelling middle-aged and older adults. Methods In total, 7330 community-dwelling subjects in the Korean Multi-Rural Communities Cohort Study were included in the analysis. Common carotid artery IMT (CCA-IMT) and plaque were evaluated by high-resolution B-mode ultrasonography. Snoring status was evaluated using a structured interview. Results Snorers had a significantly greater average CCA-IMT than non-snorers (0.726 vs 0.713 mm; P < 0.001), after adjusting for age and gender. The odds ratios (OR) for high CCA-IMT (fifth quintile) were significantly higher for snorers than for non-snorers in multivariate-adjusted analysis (OR 1.25, 95% confidence interval [CI] 1.10–1.42). However, there was no significant relationship between snoring and carotid plaques. Conclusions Our data suggest that self-reported snoring is significantly associated with increased IMT, but not with the presence of plaques. These findings suggest that early screening and intervention for snoring in the general population are needed to prevent adverse cardiovascular events.
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    • "IMT and carotid plaque are indicators of atherosclerosis and predictors of myocardial infarction and cardiovascular mortality [35,36]. A thicker IMT predicts coronary heart disease [28], stroke [29], and myocardial infarction [29,31]. "
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