Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk In Communities) study.

Description

The purpose of this study was to investigate whether carotid intima-media thickness (CIMT) and information about the presence or absence of plaque could improve coronary heart disease (CHD) risk prediction in the ARIC (Atherosclerosis Risk In Communities) study. The study sample for this analysis included 13,145 patients between 45 and 64 years of age. Results showed that using CIMT and plaque information can improve CHD risk prediction. Moreover, adding CIMT and plaque information to traditional risk factors resulted in the reclassification of ­~23% of the subjects, with a net reclassification improvement of 9.9%. However, most of the subjects were reclassified to a lower risk group than to a higher risk group. Indeed, almost 61.9% of those reclassified from the intermediate risk group (5% to 20% estimated 10-year CHD risk) were reclassified to lower risk. Furthermore, plaque presence seemed to have a more profound effect on improving risk prediction in women than in men. Thus, CIMT and identification of plaque presence improves CHD risk prediction in the ARIC study. In their comment, Stein JH and Johnson HM recognized that this study provided the best evidence to date that CIMT can improve CHD risk prediction. They also underlined the clear conclusions reached regarding CIMT imaging and the fact that these findings validated the recent consensus statement recommendations of combining CIMT and carotid plaque for optimal risk prediction in a specific category of patients.