Carotid wall thickness is predictive of incident clinical stroke: The Atherosclerosis Risk in Communities (ARIC) study

Lloyd E. Chambless, Aaron R. Folsom, Limin X. Clegg, A. Richey Sharrett, Eyal Shahar, F. Javier Nieto, Wayne D. Rosamond, Greg Evans

Research output: Contribution to journalArticle

593 Citations (Scopus)

Abstract

Few studies have determined whether carotid artery intima- media thickness (IMT) is associated prospectively with risk of first ischemic stroke. In the Atherosclerosis Risk in Communities Study, carotid IMT, an index of generalized atherosclerosis, was defined as the mean of IMT measured by B-mode ultrasonography at six sites of the carotid arteries. The authors assessed the relation of mean IMT to stroke incidence over 6-9 years' follow- up (1987-1995) among 7,865 women and 6,349 men aged 45-64 years without prior stroke at baseline in four US communities. There were 90 incident ischemic stroke events for women and 109 for men. In sex-specific Cox proportional hazards models adjusting only for age, race, and community, the hazard rate ratios comparing extreme mean IMT values (≥1 mm) to values less than 0.6 mm were 8.5 for women (95% confidence interval: 3.5, 20.7) and 3.6 for men (95% confidence interval: 1.5, 9.2). The relation was graded, and models with cubic splines indicated significant nonlinearity, with hazards increasing more rapidly at lower IMTs than at higher IMTs. Thus, models using linear IMT values substantially underestimate the strength of the association at lower IMTs. The strength of the association was reduced by the inclusion of putative stroke risk factors, but it remained elevated at higher IMTs. Hence, mean carotid IMT is a noninvasive predictor of future ischemic stroke incidence.

Original languageEnglish (US)
Pages (from-to)478-487
Number of pages10
JournalAmerican Journal of Epidemiology
Volume151
Issue number5
StatePublished - Mar 1 2000
Externally publishedYes

Fingerprint

Atherosclerosis
Stroke
Carotid Intima-Media Thickness
Carotid Arteries
Confidence Intervals
Incidence
Proportional Hazards Models
Linear Models
Ultrasonography

Keywords

  • Carotid arteries
  • Cerebrovascular disorders
  • Incidence
  • Risk factors
  • Ultrasonography

ASJC Scopus subject areas

  • Epidemiology

Cite this

Chambless, L. E., Folsom, A. R., Clegg, L. X., Sharrett, A. R., Shahar, E., Nieto, F. J., ... Evans, G. (2000). Carotid wall thickness is predictive of incident clinical stroke: The Atherosclerosis Risk in Communities (ARIC) study. American Journal of Epidemiology, 151(5), 478-487.

Carotid wall thickness is predictive of incident clinical stroke : The Atherosclerosis Risk in Communities (ARIC) study. / Chambless, Lloyd E.; Folsom, Aaron R.; Clegg, Limin X.; Sharrett, A. Richey; Shahar, Eyal; Nieto, F. Javier; Rosamond, Wayne D.; Evans, Greg.

In: American Journal of Epidemiology, Vol. 151, No. 5, 01.03.2000, p. 478-487.

Research output: Contribution to journalArticle

Chambless, LE, Folsom, AR, Clegg, LX, Sharrett, AR, Shahar, E, Nieto, FJ, Rosamond, WD & Evans, G 2000, 'Carotid wall thickness is predictive of incident clinical stroke: The Atherosclerosis Risk in Communities (ARIC) study', American Journal of Epidemiology, vol. 151, no. 5, pp. 478-487.
Chambless, Lloyd E. ; Folsom, Aaron R. ; Clegg, Limin X. ; Sharrett, A. Richey ; Shahar, Eyal ; Nieto, F. Javier ; Rosamond, Wayne D. ; Evans, Greg. / Carotid wall thickness is predictive of incident clinical stroke : The Atherosclerosis Risk in Communities (ARIC) study. In: American Journal of Epidemiology. 2000 ; Vol. 151, No. 5. pp. 478-487.
@article{500ac97607514fb792fd242bd1802db1,
title = "Carotid wall thickness is predictive of incident clinical stroke: The Atherosclerosis Risk in Communities (ARIC) study",
abstract = "Few studies have determined whether carotid artery intima- media thickness (IMT) is associated prospectively with risk of first ischemic stroke. In the Atherosclerosis Risk in Communities Study, carotid IMT, an index of generalized atherosclerosis, was defined as the mean of IMT measured by B-mode ultrasonography at six sites of the carotid arteries. The authors assessed the relation of mean IMT to stroke incidence over 6-9 years' follow- up (1987-1995) among 7,865 women and 6,349 men aged 45-64 years without prior stroke at baseline in four US communities. There were 90 incident ischemic stroke events for women and 109 for men. In sex-specific Cox proportional hazards models adjusting only for age, race, and community, the hazard rate ratios comparing extreme mean IMT values (≥1 mm) to values less than 0.6 mm were 8.5 for women (95{\%} confidence interval: 3.5, 20.7) and 3.6 for men (95{\%} confidence interval: 1.5, 9.2). The relation was graded, and models with cubic splines indicated significant nonlinearity, with hazards increasing more rapidly at lower IMTs than at higher IMTs. Thus, models using linear IMT values substantially underestimate the strength of the association at lower IMTs. The strength of the association was reduced by the inclusion of putative stroke risk factors, but it remained elevated at higher IMTs. Hence, mean carotid IMT is a noninvasive predictor of future ischemic stroke incidence.",
keywords = "Carotid arteries, Cerebrovascular disorders, Incidence, Risk factors, Ultrasonography",
author = "Chambless, {Lloyd E.} and Folsom, {Aaron R.} and Clegg, {Limin X.} and Sharrett, {A. Richey} and Eyal Shahar and Nieto, {F. Javier} and Rosamond, {Wayne D.} and Greg Evans",
year = "2000",
month = "3",
day = "1",
language = "English (US)",
volume = "151",
pages = "478--487",
journal = "American Journal of Epidemiology",
issn = "0002-9262",
publisher = "Oxford University Press",
number = "5",

}

TY - JOUR

T1 - Carotid wall thickness is predictive of incident clinical stroke

T2 - The Atherosclerosis Risk in Communities (ARIC) study

AU - Chambless, Lloyd E.

AU - Folsom, Aaron R.

AU - Clegg, Limin X.

AU - Sharrett, A. Richey

AU - Shahar, Eyal

AU - Nieto, F. Javier

AU - Rosamond, Wayne D.

AU - Evans, Greg

PY - 2000/3/1

Y1 - 2000/3/1

N2 - Few studies have determined whether carotid artery intima- media thickness (IMT) is associated prospectively with risk of first ischemic stroke. In the Atherosclerosis Risk in Communities Study, carotid IMT, an index of generalized atherosclerosis, was defined as the mean of IMT measured by B-mode ultrasonography at six sites of the carotid arteries. The authors assessed the relation of mean IMT to stroke incidence over 6-9 years' follow- up (1987-1995) among 7,865 women and 6,349 men aged 45-64 years without prior stroke at baseline in four US communities. There were 90 incident ischemic stroke events for women and 109 for men. In sex-specific Cox proportional hazards models adjusting only for age, race, and community, the hazard rate ratios comparing extreme mean IMT values (≥1 mm) to values less than 0.6 mm were 8.5 for women (95% confidence interval: 3.5, 20.7) and 3.6 for men (95% confidence interval: 1.5, 9.2). The relation was graded, and models with cubic splines indicated significant nonlinearity, with hazards increasing more rapidly at lower IMTs than at higher IMTs. Thus, models using linear IMT values substantially underestimate the strength of the association at lower IMTs. The strength of the association was reduced by the inclusion of putative stroke risk factors, but it remained elevated at higher IMTs. Hence, mean carotid IMT is a noninvasive predictor of future ischemic stroke incidence.

AB - Few studies have determined whether carotid artery intima- media thickness (IMT) is associated prospectively with risk of first ischemic stroke. In the Atherosclerosis Risk in Communities Study, carotid IMT, an index of generalized atherosclerosis, was defined as the mean of IMT measured by B-mode ultrasonography at six sites of the carotid arteries. The authors assessed the relation of mean IMT to stroke incidence over 6-9 years' follow- up (1987-1995) among 7,865 women and 6,349 men aged 45-64 years without prior stroke at baseline in four US communities. There were 90 incident ischemic stroke events for women and 109 for men. In sex-specific Cox proportional hazards models adjusting only for age, race, and community, the hazard rate ratios comparing extreme mean IMT values (≥1 mm) to values less than 0.6 mm were 8.5 for women (95% confidence interval: 3.5, 20.7) and 3.6 for men (95% confidence interval: 1.5, 9.2). The relation was graded, and models with cubic splines indicated significant nonlinearity, with hazards increasing more rapidly at lower IMTs than at higher IMTs. Thus, models using linear IMT values substantially underestimate the strength of the association at lower IMTs. The strength of the association was reduced by the inclusion of putative stroke risk factors, but it remained elevated at higher IMTs. Hence, mean carotid IMT is a noninvasive predictor of future ischemic stroke incidence.

KW - Carotid arteries

KW - Cerebrovascular disorders

KW - Incidence

KW - Risk factors

KW - Ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=0034159755&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034159755&partnerID=8YFLogxK

M3 - Article

C2 - 10707916

AN - SCOPUS:0034159755

VL - 151

SP - 478

EP - 487

JO - American Journal of Epidemiology

JF - American Journal of Epidemiology

SN - 0002-9262

IS - 5

ER -