Journal of the American Society of Echocardiography
Volume 23, Issue 8 , Pages 809-815 , August 2010

High Prevalence of Ultrasound Detected Carotid Atherosclerosis in Subjects with Low Framingham Risk Score: Potential Implications for Screening for Subclinical Atherosclerosis

This study was presented in abstract form at the 2008 Annual Scientific Sessions of the American College of Cardiology.

  • Tasneem Z. Naqvi, MD, FRCP, FACC, FRCP

      Affiliations

    • Cardiac Non Invasive Laboratory, Keck School of Medicine, University of Southern California, Los Angeles, California
    • Corresponding Author InformationReprint requests: Tasneem Z. Naqvi, MD, FRCP, FACC, University of Southern California, Keck School of Medicine, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033.
  • ,
  • Fernando Mendoza, MD

      Affiliations

    • Atherosclerosis Research Center and Mark Taper Imaging Center, Cedars Sinai Heart Institute, Los Angeles, California
  • ,
  • Farhad Rafii, MD

      Affiliations

    • Atherosclerosis Research Center and Mark Taper Imaging Center, Cedars Sinai Heart Institute, Los Angeles, California
  • ,
  • Heidi Gransar

      Affiliations

    • Atherosclerosis Research Center and Mark Taper Imaging Center, Cedars Sinai Heart Institute, Los Angeles, California
  • ,
  • Maria Guerra

      Affiliations

    • Atherosclerosis Research Center and Mark Taper Imaging Center, Cedars Sinai Heart Institute, Los Angeles, California
  • ,
  • Norman Lepor, MD, FACC, FAHA

      Affiliations

    • Atherosclerosis Research Center and Mark Taper Imaging Center, Cedars Sinai Heart Institute, Los Angeles, California
  • ,
  • Daniel S. Berman, MD, FACC, FAHA

      Affiliations

    • Atherosclerosis Research Center and Mark Taper Imaging Center, Cedars Sinai Heart Institute, Los Angeles, California
  • ,
  • Prediman K. Shah, MD, FACC, FAHA

      Affiliations

    • Atherosclerosis Research Center and Mark Taper Imaging Center, Cedars Sinai Heart Institute, Los Angeles, California

References 

  1. American Heart Association . Heart disease and stroke statistics—2005 update. Dallas, TX: American Heart Association; 2005;
  2. Stamler J, Stamler R, Neaton JD, Wentworth D, Daviglus ML, Garside D, et al. Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 1999;282:2012–2018
  3. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK. Cardiovascular Health Study Collaborative Research Group. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med. 1999;340:14–22
  4. Salonen JT, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation. 1993;(suppl):87;II56-65
  5. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett 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;146:483–494
  6. Salonen R, Salonen JT. Progression of carotid atherosclerosis and its determinants: a population-based ultrasonography study. Atherosclerosis. 1990;81:33–40
  7. Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Mosler TP, Tseng PH, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49:1860–1870
  8. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291:210–215
  9. Salonen R, Salonen JT. Determinants of carotid intima-media thickness: a population-based ultrasonography study in eastern Finnish men. J Intern Med. 1991;229:225–231
  10. Bonithon-Kopp C, Scarabin P, Taquet A, Touboul P, Malmejac A, Guize L. Risk factors for early carotid atherosclerosis in middle-aged French women. Arterioscler Thromb. 1991;11:966–972
  11. Folsom AR, Eckfeldt JH, Weitzman S, Ma J, Chambless LE, Barnes RW, et al. Relation of carotid artery wall thickness to diabetes mellitus, fasting glucose and insulin, body size, and physical activity. Stroke. 1994;25:66–73
  12. Howard G, Burke GL, Szklo M, Tell GS, Eckfeldt J, Evans G, et al. Active and passive smoking are associated with increased carotid wall thickness: the Atherosclerosis Risk in Communities Study. Arch Intern Med. 1994;154:1277–1282
  13. Li S, Chen W, Srinivasan SR, Bond MG, Tang R, Urbina EM, et al. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA. 2003;290:2271–2276
  14. Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003;290:2277–2283
  15. Berman DS, Hachamovitch R, Kiat H, Cohen I, Cabico JA, Wang FP, et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m Sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardio.l. 1995;26:639–647
  16. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–832
  17. Raggi P, Callister TQ, Cooil B, He ZX, Lippolis NJ, Russo DJ, et al. Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography. Circulation. 2000;101:850–855
  18. Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Desvarieux M, et al. Mannheim intima-media thickness consensus. On behalf of the advisory board of the 3rd Watching the Risk Symposium 2004, 13th European Stroke Conference, Mannheim, Germany, May 14, 2004. Cerebrovasc Dis. 2004;18:346–349
  19. Grundy SM. Age as a risk factor: you are as old as your arteries. Am J Cardiol. 1999;83:1455–1457
  20. Stein JH, Fraizer MC, Aeschlimann SE, Nelson-Worel J, McBride PE, Douglas PS. Vascular age: integrating carotid intima-media thickness measurements with global coronary risk assessment. Clin Cardiol. 2004;27:388–392
  21. Budoff MJ. Atherosclerosis imaging and calcified plaque: coronary artery disease risk assessment. Prog Cardiovasc Dis. 2003;46:135–145
  22. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–1847
  23. Postley JE, Perez A, Wong ND, Gardin JM. Prevalence and distribution of sub-clinical atherosclerosis by screening vascular ultrasound in low and intermediate risk adults: the New York physicians study. J Am Soc Echocardiogr. 2009;22:1145–1151
  24. Naghavi M, Falk E, Hecht HS, Jamieson MJ, Kaul S, Berman D, et al From vulnerable plaque to vulnerable patient-part III: executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol. 2006;98(suppl):2–15
  25. Kim KP, Enstein AJ. Berrington de Gonzalez A. Coronary artery calcification screening. Estimated radiation dose and cancer risk. Arch Intern Med. 2009;1169:1188–1194
  26. Korcarz CE, Hirsch AT, Bruce C, DeCara JM, Mohler ER, Pogue B, et al. Carotid intima-media thickness testing by non-sonographer clinicians: the office practice assessment of carotid atherosclerosis study. J Am Soc Echocardiogr. 2008;21:117–122
  27. Belcaro G, Nicolaides AN, Laurora G, Cesarone MR, De Sanctis M, Incandela L, et al. Ultrasound morphology classification of the arterial wall and cardiovascular events in a 6-year follow-up study. Arterioscler Thromb Vasc Biol. 1996;16:851–856
  28. 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;96:1432–1437
  29. Nambi V, Chambles L, Folsom AR, He M, Hu Y, Mosley T, et al. Carotid intima media thickness and presence or absence of plaque improves prediction of coronary heart disease risk. The ARIC (Atherosclerosis Risk in Communities) study. J Am Coll Cardiol. 2010;55:1600–1607
  30. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336–1345
  31. Lakoski SG, Greenland P, Wong ND, Schreiner PJ, Herrington DM, Kronmal RA, et al. Coronary artery calcium scores and risk for cardiovascular events in women classified as “low risk” based on Framingham risk score. The Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med. 2007;167:2437–2442
  32. Crouse JR, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH, et al. METEOR Study Group Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR trial. JAMA. 2007;297:1344–1353
  33. Newman AB, Naydeck BL, Sutton-Tyrrell K, Edmundowicz D, O'Leary D, Kronmal R, et al. Relationship between coronary artery calcification and other measures of subclinical cardiovascular disease in older adults. Arterioscler Thromb Vasc Biol. 2002;22:1674–1679
  34. Al-Shali K, House AA, Hanley AJ, Khan HM, Harris SB, Mamakeesick M, et al. Differences between carotid wall morphological phenotypes measured by ultrasound in one, two and three dimensions. Atherosclerosis. 2005;178:319–325
  35. 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
  36. Rundek T, Arif H, Boden-Albala B, Elkind MS, Paik MC. Sacco RL.Carotid plaque, a subclinical precursor of vascular events: the Northern Manhattan Study. Neurology. 2008;70:1200–1207

 Dr Berman has a research grant with GE Medical Systems (Milwaukee, WI).

PII: S0894-7317(10)00367-6

doi: 10.1016/j.echo.2010.05.005

Journal of the American Society of Echocardiography
Volume 23, Issue 8 , Pages 809-815 , August 2010