Letter by Rundek et al Regarding Article, “Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis”
2007; Lippincott Williams & Wilkins; Volume: 116; Issue: 9 Linguagem: Inglês
10.1161/circulationaha.107.696385
ISSN1524-4539
AutoresTatjana Rundek, Robert D. Brook, J. David Spence,
Tópico(s)Blood Pressure and Hypertension Studies
ResumoHomeCirculationVol. 116, No. 9Letter by Rundek et al Regarding Article, "Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Rundek et al Regarding Article, "Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis" Tatjana Rundek, MD, PhD Robert D. Brook, MD J. David Spence, MD, FRCPC Tatjana RundekTatjana Rundek Division of Stroke, Department of Neurology, Columbia University, New York, NY Robert D. BrookRobert D. Brook Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich J. David SpenceJ. David Spence Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario, Canada Originally published28 Aug 2007https://doi.org/10.1161/CIRCULATIONAHA.107.696385Circulation. 2007;116:e317To the Editor:We congratulate Lorenz et al1 on their review of carotid intima-media thickness (IMT). The authors acknowledged that the heterogeneity among IMT measurement methodologies and study populations are the most important limitation of their metaanalysis. It is surprising however that the paper lacks discussion regarding the prognostic importance of the presence of carotid plaque. Moreover, no information was provided on plaque prevalence or on the effect that incorporation of plaque into IMT measurements likely had on the results.Carotid plaque is a distinctive phenotype of atherosclerosis that poses a higher likelihood of rupture, thrombosis, rapid progression, responds to factors that affect endothelial function, and represents remodeling to minimize flow disturbances.2 In contrast, IMT principally represents hypertensive hypertrophy of the media and is under a substantial genetic control different from that of plaque.2 Carotid plaque most likely is not a simple continuum of IMT progression. Most importantly, recent evidence shows that carotid plaque predicts myocardial infarction risk and the extent of underlying coronary artery disease better than does IMT.2–4Plaque is not a rare finding as the authors suggested. The prevalence of atherosclerotic carotid plaque is ≈40% to 60% in the general population over age of 40 years and approaches 100% at age 70.2,5 Therefore, the prevalence of carotid plaque should not be underestimated in studies of preclinical atherosclerotic burden. Moreover, all IMT studies in this pooled analysis consisted mainly of Caucasian populations (with the exception of the Atherosclerosis Risk in Communities study). The results from multiethnic populations with high representation of Hispanics and blacks have shown high prevalence of carotid plaque.5 Presence of plaque, in contrast to the authors' statement, may be an important confounder in the predictive models of IMT.Most IMT studies in this analysis incorporated measurements of plaque into the IMT measurements. In some, IMT was dichotomized above and below a threshold level of IMT, which produced the effect of pooling subjects with plaques into the higher IMT level group because plaques tend to be more common in those with a thicker IMT. Inclusion of plaque thickness in IMT measurement may have been responsible for a significant association of plaque thickness, rather than IMT, with vascular outcomes. Separate characterization of plaque and IMT is prudent to derive better information on vascular disease risk.DisclosuresNone.1 Lorenz MW, Marcus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007; 115: 459–467.LinkGoogle Scholar2 Spence JD. Technology insight: ultrasound measurement of carotid plaque-patient management, genetic research, and therapy evaluation. Nat Clin Pract Neurol. 2006; 11: 611–619.CrossrefGoogle Scholar3 Spence JD, Eliasziw M, DiCicco M, Hackam DG, Galil G, Lohmann T. Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. Stroke. 2002; 33: 2916–2922.LinkGoogle Scholar4 Brook RD, Bard RL, Patel S, Rubenfire M, Clarke NS, Kazerooni EA, Wakefield TW, Henke PK, Eagle KA. A negative carotid plaque area test is superior to other noninvasive atherosclerosis studies for reducing the likelihood of having underlying significant coronary artery disease. Arterioscler Thromb Vasc Biol. 2006; 26: 656–662.LinkGoogle Scholar5 Prabhakaran S, Rundek T, Ramas R, Elkind MS, Paik MC, Boden-Albala B, Sacco RL. Carotid plaque surface irregularity predicts ischemic stroke: the Northern Manhattan Study. Stroke. 2006; 37: 2696–2701.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Huang R, Mills K, Romero J, Li Y, Hu Z, Cao Y, Huang H, Xu Y and Jiang L (2019) Comparative effects of lipid lowering, hypoglycemic, antihypertensive and antiplatelet medications on carotid artery intima-media thickness progression: a network meta-analysis, Cardiovascular Diabetology, 10.1186/s12933-019-0817-1, 18:1, Online publication date: 1-Dec-2019. Della-Morte D, Dong C, Markert M, Elkind M, Sacco R, Wright C and Rundek T (2017) Carotid Intima-Media Thickness Is Associated With White Matter Hyperintensities, Stroke, 49:2, (304-311), Online publication date: 1-Feb-2018. Della-Morte D, Dong C, Beecham A, Wang L, Cabral D, Markert M, Blanton S, Sacco R and Rundek T (2015) Relationship between sirtuin and mitochondrial uncoupling protein genes and carotid artery stiffness, Translational Research, 10.1016/j.trsl.2014.08.007, 165:2, (358-359), Online publication date: 1-Feb-2015. Beamish A and Olbers T (2015) Bariatric and Metabolic Surgery in Adolescents: a Path to Decrease Adult Cardiovascular Mortality, Current Atherosclerosis Reports, 10.1007/s11883-015-0532-7, 17:9, Online publication date: 1-Sep-2015. Galesloot T, Holewijn S, Kiemeney L, de Graaf J, Vermeulen S and Swinkels D (2013) Serum Hepcidin Is Associated With Presence of Plaque in Postmenopausal Women of a General Population, Arteriosclerosis, Thrombosis, and Vascular Biology, 34:2, (446-456), Online publication date: 1-Feb-2014. Della-Morte D, Guadagni F, Palmirotta R, Testa G, Caso V, Paciaroni M, Abete P, Rengo F, Ferroni P, Sacco R and Rundek T (2012) Genetics of ischemic stroke, stroke-related risk factors, stroke precursors and treatments, Pharmacogenomics, 10.2217/pgs.12.14, 13:5, (595-613), Online publication date: 1-Apr-2012. Inaba Y, Chen J and Bergmann S (2012) Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: A meta-analysis, Atherosclerosis, 10.1016/j.atherosclerosis.2011.06.044, 220:1, (128-133), Online publication date: 1-Jan-2012. Della-Morte D, Beecham A, Dong C, Wang L, McClendon M, Gardener H, Blanton S, Sacco R and Rundek T (2012) Association between variations in coagulation system genes and carotid plaque, Journal of the Neurological Sciences, 10.1016/j.jns.2012.08.020, 323:1-2, (93-98), Online publication date: 1-Dec-2012. Botnar R and Makowski M (2011) Molecular MRI of Atherosclerosis Burden, Current Cardiovascular Imaging Reports, 10.1007/s12410-011-9116-2, 5:1, (26-35), Online publication date: 1-Feb-2012. Rundek T and Polak J (2011) Cardiovascular Risk Factors and Carotid Ultrasound Cerebrovascular Ultrasound in Stroke Prevention and Treatment, 10.1002/9781444327373.ch8, (158-176), Online publication date: 11-Feb-2011. Rundek T and Salameh M (2010) Carotid Plaque Assessment, Journal of the American College of Cardiology, 10.1016/j.jacc.2010.04.051, 56:13, (1069), Online publication date: 1-Sep-2010. Stuenkel C (2008) Does the yardstick of cardiovascular risk assessment really measure up?, Menopause, 10.1097/gme.0b013e3181639ba2, 15:2, (212-214), Online publication date: 1-Mar-2008. Della-Morte D, Gardener H, Dong C, Markert M, Cabral D, Elkind M, Sacco R and Rundek T (2018) Association Between Carotid Artery Function and Structure in the Northern Manhattan Study, Frontiers in Neurology, 10.3389/fneur.2018.00246, 9 August 28, 2007Vol 116, Issue 9 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.696385PMID: 17724268 Originally publishedAugust 28, 2007 PDF download Advertisement SubjectsImaging
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