Comparison of Carotid Intima-Media Thickness in Patients With Stable Angina Pectoris Versus Patients With Acute Coronary Syndrome

doi:10.1016/j.amjcard.2005.04.035

The American Journal of Cardiology

Volume 96, Issue 5, 1 September 2005, Pages 643-644

https://doi.org/10.1016/j.amjcard.2005.04.035 Get rights and content

In this study, we found that carotid intima-media thickness (IMT) was significantly increased and carotid artery atherosclerotic plaques were detected more frequently in patients who had early-onset coronary artery disease compared with control subjects (0.73 ± 0.10 vs 0.60 ± 0.10 mm, p <0.001, and 40% vs 11%, p <0.001, respectively). Further, patients who had coronary artery disease and presented with an acute coronary syndrome were found to have significantly increased carotid IMT compared with patients who had stable angina pectoris (0.76 ± 0.10 vs 0.70 ± 0.10 mm, p <0.05). The IMT was greater in the patients who had acute coronary syndrome than in those who had stable angina pectoris.

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There are more references available in the full text version of this article.

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We aimed to compare the prevalence of modifiable and non-modifiable coronary heart disease (CHD) risk factors among those with premature CHD and healthy individuals.
PubMed, CINAHL, Embase, and Web of Science databases were searched (review protocol is registered in PROSPERO CRD42020173216). The quality of studies was assessed using the National Heart, Lung and Blood Institute tool for cross-sectional, cohort and case-control studies. Meta-analyses were performed using Review Manager 5.3. Effect sizes for categorical and continuous variables, odds ratio (OR) and mean differences (MD)/standardised mean differences (SMD) with 95% confidence intervals (CI) were reported.
A total of n=208 primary studies were included in this review. Individuals presenting with premature CHD (PCHD, age ≤65 years) had higher mean body mass index (MD 0.54 kg/m², 95% CI 0.24, 0.83), total cholesterol (SMD 0.27, 95% CI 0.17, 0.38), triglycerides (SMD 0.50, 95% CI 0.41, 0.60) and lower high-density lipoprotein cholesterol (SMD 0.79, 95% CI: −0.91, −0.68) compared with healthy individuals. Individuals presenting with PCHD were more likely to be smokers (OR 2.88, 95% CI 2.51, 3.31), consumed excessive alcohol (OR 1.40, 95% CI 1.05, 1.86), had higher mean lipoprotein (a) levels (SMD 0.41, 95% CI 0.28, 0.54), and had a positive family history of CHD (OR 3.65, 95% CI 2.87, 4.66) compared with healthy individuals. Also, they were more likely to be obese (OR 1.59, 95% CI 1.32, 1.91), and to have had dyslipidaemia (OR 2.74, 95% CI 2.18, 3.45), hypertension (OR 2.80, 95% CI 2.28, 3.45), and type 2 diabetes mellitus (OR 2.93, 95% CI 2.50, 3.45) compared with healthy individuals.
This meta-analysis confirms current knowledge of risk factors for PCHD, and identifying these early may reduce CHD in young adults.
Measurements of carotid intima-media thickness and of interadventitia common carotid diameter improve prediction of cardiovascular events: Results of the IMPROVE (carotid intima media thickness [IMT] and IMT-progression as predictors of vascular events in a high risk European population) study
2012, Journal of the American College of Cardiology
The goal of this study was to compare the performance of several measures of carotid intima-media thickness (C-IMT) as predictors of cardiovascular events (CVEs), and to investigate whether they add to the predictive accuracy of Framingham risk factors (FRFs).
Various markers of subclinical atherosclerosis have been identified as predictors of CVEs, but the most powerful variable is still under debate.
A cohort study was carried out in 5 European countries. A total of 3,703 subjects (median age 64.4 years; 48% men) were followed-up for a median of 36.2 months, and 215 suffered a first CVE (incidence: 19.9/1,000 person-years).
All measures of C-IMT and the interadventitia common carotid artery diameter (ICCAD) were associated with the risk of CVEs, after adjustment for FRFs and therapies (all p < 0.005). The average of 8 maximal IMT measurements (IMT_mean-max), alone or combined with ICCAD, classified events and non-events better than the common carotid mean IMT (net reclassification improvement [NRI]: +11.6% and +19.9%, respectively; both p < 0.01). Compared with classification based on FRFs alone, the NRI resulting from the combination of FRFs+ICCAD+IMT_mean-max was +12.1% (p < 0.01). The presence of at least 1 plaque (maximum IMT >1.5 mm) performed significantly worse than composite IMTs that incorporated plaques (p < 0.001). Adjusted Kaplan-Meier curves showed that individuals with a FRS = 22.6% (cohort average), and both IMT_mean-max and ICCAD above the median, had a 6.5% risk to develop a CVE over 3 years versus a 3.4% risk for those with the same FRS, and both IMT_mean-max and ICCAD below the median.
A risk stratification strategy based on C-IMT and ICCAD as an adjunct to FRFs is a rational approach to prevention of cardiovascular disease.
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Citation Excerpt :
Furthermore, two large observational studies raised the possibility of cerebral vessel involvement in patients with acute MI, supporting the concept of multi-plaque instability and systemic arterial involvement during ACS secondary to systemic activation of the inflammatory markers [16,17]. Several studies have been conducted for detecting the atherosclerotic changes in various vascular beds and for evaluating the relationship between the severity of CAD and peripheral vascular atherosclerotic changes [12–15,18–20]. However, the involvement of the thoracic aorta during NSTEMI, especially utilizing an advanced cardiovascular magnetic resonance (CMR) imaging has not been well evaluated.
Inflammation has been shown to be a major component in the pathophysiology of acute coronary syndrome (ACS). In patients presenting with acute myocardial infarction (AMI), a critical component of the ACS spectrum, multiple coronary arteries are involved during this inflammatory process. In addition to the coronary vasculature, the inflammatory cascade has also been shown to affect the carotid arteries and possibly the aorta.
To assess the involvement of the aorta during AMI by cardiac magnetic resonance (CMR).
We prospectively evaluated the aortic wall by CMR in 123 patients. 78 patients were enrolled from the emergency department (ED), who presented with chest pain and were classified as either: (1) AMI: elevated troponin levels and typical chest pain or (2) non-cardiac chest pain (CP): negative troponins and a normal stress test or normal cardiac catheterization. We compared these 2 groups to a group of 45 asymptomatic diabetic patients. The descending thoracic aortic wall area (AWA) and maximal aortic wall thickness (AWT) were measured using a double inversion recovery T-2 weighted, ECG-gated, spin echo sequence by CMR.
Patients with AMI were older, more likely to smoke, had a higher incidence of claudication, and had higher CRP levels. The AWA and maximal AWT were greater in patients who presented to the ED with ACS (2.11 ± 0.17 mm², and 3.17 ± 0.19 mm, respectively) than both patients presenting with non-cardiac CP (1.52 ± 0.58 mm², p < 0.001; and 2.57 ± 0.10 mm, p < 0.001) and the diabetic patients (1.38 ± 0.58 mm², p < 0.001; and 2.30 ± 0.131 mm, p < 0.001). The difference in the aortic wall characteristics remained significant after correcting for body mass index, hyperlipidemia, statins and C-reactive protein. There was no difference in maximal AWT or AWA between patients with non-cardiac CP and patients with diabetes.
Patients with AMI have a significantly greater maximal aortic wall thickness and area compared to patients with non-cardiac CP. Longitudinal studies are needed to assess whether this increase is due to inflammation or a higher atherosclerotic burden.
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Coronary artery diseaseComparison of Carotid Intima-Media Thickness in Patients With Stable Angina Pectoris Versus Patients With Acute Coronary Syndrome

Association of increased carotid intima-media thickness with the extent of coronary artery disease

Heart

Inflammation as a possible link between coronary and carotid plaque instability

Circulation

Coronary artery disease
Comparison of Carotid Intima-Media Thickness in Patients With Stable Angina Pectoris Versus Patients With Acute Coronary Syndrome