Predictive value of noninvasive measures of atherosclerosis for incident myocardial infarction: the Rotterdam Study.

Abstract:

BACKGROUND:Several noninvasive methods are available to investigate the severity of extracoronary atherosclerotic disease. No population-based study has yet examined whether differences exist between these measures with regard to their predictive value for myocardial infarction (MI) or whether a given measure of atherosclerosis has predictive value independently of the other measures. METHODS AND RESULTS:At the baseline (1990-1993) examination of the Rotterdam Study, a population-based cohort study among subjects age > or =55 years, carotid plaques and intima-media thickness (IMT) were measured by ultrasound, abdominal aortic atherosclerosis by x-ray, and lower-extremity atherosclerosis by computation of the ankle-arm index. In the present study, 6389 subjects were included; 258 cases of incident MI occurred before January 1, 2000. All 4 measures of atherosclerosis were good predictors of MI independently of traditional cardiovascular risk factors. Hazard ratios were equally high for carotid plaques (1.83 [1.27 to 2.62], severe versus no atherosclerosis), carotid IMT (1.95 [1.19 to 3.19]), and aortic atherosclerosis (1.94 [1.30 to 2.90]) and slightly lower for lower-extremity atherosclerosis (1.59 [1.05 to 2.39]), although differences were small. The hazard ratio for MI for subjects with severe atherosclerosis according to a composite atherosclerosis score was 2.77 (1.70 to 4.52) compared with subjects with no atherosclerosis. The predictive value of MI for a given measure of atherosclerosis was independent of the other atherosclerosis measures. CONCLUSIONS:Noninvasive measures of extracoronary atherosclerosis are strong predictors of MI. The relatively crude measures directly assessing plaques in the carotid artery and abdominal aorta predict MI equally well as the more precisely measured carotid IMT.

journal_name

Circulation

journal_title

Circulation

authors

van der Meer IM,Bots ML,Hofman A,del Sol AI,van der Kuip DA,Witteman JC

doi

10.1161/01.CIR.0000120708.59903.1B

subject

Has Abstract

pub_date

2004-03-09 00:00:00

pages

1089-94

issue

9

eissn

0009-7322

issn

1524-4539

pii

01.CIR.0000120708.59903.1B

journal_volume

109

pub_type

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