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• W2034205462 abstract "HomeCirculationVol. 116, No. 9Response to Letter 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/EPUBResponse to Letter Regarding Article, “Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis” Matthias W. Lorenz, MD and Matthias Sitzer, MD, PhD Hugh S. Markus, MD, PhD, FRCP Michiel L. Bots, MD, PhD Maria Rosvall, MD, PhD Matthias W. LorenzMatthias W. Lorenz Johann Wolfgang Goethe-University, Department of Neurology, Frankfurt am Main, Germany Search for more papers by this author and Matthias SitzerMatthias Sitzer Johann Wolfgang Goethe-University, Department of Neurology, Frankfurt am Main, Germany Search for more papers by this author Hugh S. MarkusHugh S. Markus Clinical Neurosciences, St. George’s University of London, London, United Kingdom Search for more papers by this author Michiel L. BotsMichiel L. Bots Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Search for more papers by this author Maria RosvallMaria Rosvall Department of Community Medicine, Lund University, Malmo University Hospital, Malmo, Sweden Search for more papers by this author Originally published28 Aug 2007https://doi.org/10.1161/CIRCULATIONAHA.107.707067Circulation. 2007;116:e318We thank Dr Rundek and her coauthors for their contribution on this very important issue. As plaque formation represents a later stage of atherosclerosis than diffuse intima-media thickening, it is likely that plaque formation is more predictive for vascular events than intima-media thickness (IMT), although formal comparisons between the 2 measurements in terms of risk relations are limited. For example, van der Meer et al1 indicated that plaques show a somewhat higher risk estimate than IMT, but the differences are small. In addition, one should bear in mind that in several studies, IMT is used as a marker of generalized risk and not necessarily of local atherosclerosis, and with that reasoning inclusion of thicker segments or plaques in the carotid IMT measurement is not a relevant issue. Ultrasound assessment of carotid plaque bears a number of problems, some of which are listed here.From a pathoanatomical point of view, an atherosclerotic plaque (a Stary type [III-] IV-V lesion) is defined as focal thickening of the arterial wall with protrusion into the lumen and the presence of lipid-laden macrophages, extracellular lipid accumulation, and a fibrous cap.2 The latter criterion is not reliably identifiable with ultrasound, despite some efforts that have been made. In studies based on high-resolution B-mode ultrasound, the definition of plaque relies on the first criterion of this definition. Unfortunately, no uniform definition of plaque assessment with the use of ultrasound has prevailed so far; the definition of a recent consensus paper3 has not yet widely been implemented in current studies and also uses an arbitrary definition of plaque. Naturally, the prevalence of plaque is highly dependent on the definition used. Even when uniform criteria are used, the application of the criterion of a focal lesion remains subjective to a certain degree. This is reflected in a lower reproducibility of the plaque measurements as compared with the carotid IMT measurement.Furthermore, studies that assess carotid plaques are highly inhomogeneous in terms of the classification of subjects. Continuous parameters that reflect the plaque burden are statistically most powerful,4 followed by ordinal plaque scores. Plaque scores that count the number of carotid segments affected are most frequently used. However, these scores imply that the predictivity of plaques is independent of their localization, which is unlikely.And although we do acknowledge that plaques are an important manifestation of atherosclerosis, IMT measurements are particularly relevant in areas of research where plaques have not yet developed (ie, among younger age groups).These and further issues are highly relevant in the review of the literature on carotid plaque and clinical vascular end points, which may justify greater expenditure than just an aspect secondary to IMT. A recent review considered most of these points,5 but some of the resulting questions can only be answered on the basis of an individual data meta-analysis. We strongly advocate such an analysis in cooperation with all relevant study groups.DisclosuresNone.1 Van der Meer IM, Bots ML, Hofman A, del Sol AI, van der Kuip DA, Witteman JC. Predictive value of noninvasive measures of atherosclerosis for incident myocardial infarction: the Rotterdam Study. Circulation. 2004; 109: 1089–1094.LinkGoogle Scholar2 Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, Rosenfeld ME, Schwartz CJ, Wagner WD, Wissler RW. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis: a report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. 1995; 92: 1355–1374.CrossrefMedlineGoogle Scholar3 Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, Csiba L, Desvarieux M, Ebrahim S, Fatar M, Hernandez Hernandez R, Jaff M, Kownator S, Prati P, Rundek T, Sitzer M, Schminke U, Tardif JC, Taylor A, Vicaut E, Woo KS, Zannad F, Zureik M. Mannheim carotid intima-media thickness consensus (2004–2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis. 2007; 23: 75–80.CrossrefMedlineGoogle Scholar4 Spence JD, Eliasziw M, DiCicco M, Hackam DG, Galil R, Lohmann T. Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. Stroke. 2002; 33: 2916–2922.LinkGoogle Scholar5 Wyman RA, Mays ME, McBride PE, Stein JH. Ultrasound-detected carotid plaque as a predictor of cardiovascular events. Vasc Med. 2006; 11: 123–130.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Meireles-Brandão J, Meireles-Brandão L, Coelho R and Rocha-Gonçalves F (2022) Long-term outcomes of primary cardiovascular prevention: A retrospective study at a referral center in Portugal, Revista Portuguesa de Cardiologia, 10.1016/j.repc.2021.05.017, Online publication date: 1-May-2022. Yalcin Bahat P, Özel A and Demirci A Evaluation of Carotid Artery Intima-Media Thickness as a Cardiovascular Risk Factor in Patients With Polycystic Ovary Syndrome, Cureus, 10.7759/cureus.13025 Barroso W, Melo M, Vitorino P, Gonçalves C, Berigó J, Arantes A, Rezende J, Jardim T, Souza A and Jardim P (2020)(2020) Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept, International Journal of Cardiovascular Sciences, 10.36660/ijcs.20190117, Online publication date: 25-Aug-2020., Online publication date: 25-Aug-2020. Alkhodari M, Islayem D, Alskafi F and Khandoker A Predicting Hypertensive Patients With Higher Risk of Developing Vascular Events Using Heart Rate Variability and Machine Learning, IEEE Access, 10.1109/ACCESS.2020.3033004, 8, (192727-192739) Jamthikar A, Gupta D, Saba L, Khanna N, Viskovic K, Mavrogeni S, Laird J, Sattar N, Johri A, Pareek G, Miner M, Sfikakis P, Protogerou A, Viswanathan V, Sharma A, Kitas G, Nicolaides A, Kolluri R and Suri J (2020) Artificial intelligence framework for predictive cardiovascular and stroke risk assessment models: A narrative review of integrated approaches using carotid ultrasound, Computers in Biology and Medicine, 10.1016/j.compbiomed.2020.104043, 126, (104043), Online publication date: 1-Nov-2020. Jamthikar A, Gupta D, Puvvula A, Johri A, Khanna N, Saba L, Mavrogeni S, Laird J, Pareek G, Miner M, Sfikakis P, Protogerou A, Kitas G, Kolluri R, Sharma A, Viswanathan V, Rathore V and Suri J (2020) Cardiovascular risk assessment in patients with rheumatoid arthritis using carotid ultrasound B-mode imaging, Rheumatology International, 10.1007/s00296-020-04691-5, 40:12, (1921-1939), Online publication date: 1-Dec-2020. Zhou R, Ma W, Fenster A, Ding M, Hahn H and Mori K (2019) U-Net based automatic carotid plaque segmentation from 3D ultrasound images Computer-Aided Diagnosis, 10.1117/12.2511932, 9781510625471, (157) Khanna N, Jamthikar A, Araki T, Gupta D, Piga M, Saba L, Carcassi C, Nicolaides A, Laird J, Suri H, Gupta A, Mavrogeni S, Kitas G and Suri J (2019) Nonlinear model for the carotid artery disease 10‐year risk prediction by fusing conventional cardiovascular factors to carotid ultrasound image phenotypes: A Japanese diabetes cohort study, Echocardiography, 10.1111/echo.14242, 36:2, (345-361), Online publication date: 1-Feb-2019. Magalhães J, Melo X, Correia I, Ribeiro R, Raposo J, Dores H, Bicho M and Sardinha L (2019) Effects of combined training with different intensities on vascular health in patients with type 2 diabetes: a 1-year randomized controlled trial, Cardiovascular Diabetology, 10.1186/s12933-019-0840-2, 18:1, Online publication date: 1-Dec-2019. Sandesara C, Sullivan R, Russo A, Li W, Kendig A, Day J, Mullin C, Stolen K and Olshansky B (2010) Older Persons with Diabetes Receive Fewer Inappropriate ICD Shocks: Results from the INTRINSIC RV Trial, Journal of Cardiovascular Translational Research, 10.1007/s12265-010-9236-0, 4:1, (27-34), Online publication date: 1-Feb-2011. Torres-Peña J, Rangel-Zuñiga O, Alcala-Diaz J, Lopez-Miranda J and Delgado-Lista J (2020) Mediterranean Diet and Endothelial Function: A Review of its Effects at Different Vascular Bed Levels, Nutrients, 10.3390/nu12082212, 12:8, (2212) Wu H, Xu M, Hao H, Hill M, Xu C and Liu Z (2022) Endothelial Dysfunction and Arterial Stiffness in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis, Journal of Clinical Medicine, 10.3390/jcm11113179, 11:11, (3179) August 28, 2007Vol 116, Issue 9 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.707067 Originally publishedAugust 28, 2007 PDF download Advertisement SubjectsEpidemiologyPathophysiology" @default.
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