Bots M L, Hoes A W, Koudstaal P J, Hofman A, Grobbee D E
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, Netherlands.
Circulation. 1997 Sep 2;96(5):1432-7. doi: 10.1161/01.cir.96.5.1432.
Noninvasive assessment of intima-media thickness (IMT) is widely used in observational studies and trials as an intermediate or proxy end point for cardiovascular disease. However, data showing that IMT predicts cardiovascular disease are limited. We studied whether common carotid IMT is related to future stroke and myocardial infarction.
We used a nested case-control approach among 7983 subjects aged > or =55 years participating in the Rotterdam Study. At baseline (March 1990 through July 1993), ultrasound images of the common carotid artery were stored on videotape. Determination of incident myocardial infarction and stroke was predominantly based on hospital discharge records. Analysis (logistic regression) was based on 98 myocardial infarctions and 95 strokes that were registered before December 31, 1994. IMT was measured from videotape for all case subjects and a sample of 1373 subjects who remained free from myocardial infarction and stroke during follow-up. The mean duration of follow-up was 2.7 years. Results were adjusted for age and sex. Stroke risk increased gradually with increasing IMT. The odds ratio for stroke per standard deviation increase (0.163 mm) was 1.41 (95% CI, 1.25 to 1.82). For myocardial infarction, an odds ratio of 1.43 (95% CI, 1.16 to 1.78) was found. When subjects with a previous myocardial infarction or stroke were excluded, odds ratios were 1.57 (95% CI, 1.27 to 1.94) for stroke and 1.51 (95% CI, 1.18 to 1.92) for myocardial infarction. Additional adjustment for several cardiovascular risk factors attenuated these associations: 1.34 (95% CI, 1.08 to 1.67) and 1.25 (95% CI, 0.98 to 1.58), respectively.
The present study, based on a short follow-up period, provides evidence that an increased common carotid IMT is associated with future cerebrovascular and cardiovascular events.
在观察性研究和试验中，作为心血管疾病的一个中间或替代终点，对内膜中层厚度（IMT）进行无创评估被广泛应用。然而，显示IMT可预测心血管疾病的数据有限。我们研究了颈总动脉IMT是否与未来的中风和心肌梗死相关。
我们在参与鹿特丹研究的7983名年龄≥55岁的受试者中采用了巢式病例对照研究方法。在基线期（1990年3月至1993年7月），颈总动脉的超声图像被存储在录像带上。心肌梗死和中风发病情况的确定主要基于医院出院记录。分析（逻辑回归）基于1994年12月31日前登记的98例心肌梗死和95例中风病例。从录像带中测量了所有病例受试者以及1373名在随访期间未发生心肌梗死和中风的受试者样本的IMT。平均随访时间为2.7年。结果根据年龄和性别进行了调整。中风风险随着IMT的增加而逐渐升高。每增加一个标准差（0.163毫米）的中风优势比为1.41（95%可信区间，1.25至1.82）。对于心肌梗死，优势比为1.43（95%可信区间，1.16至1.78）。排除既往有心肌梗死或中风的受试者后，中风的优势比为1.57（95%可信区间，1.27至1.94），心肌梗死的优势比为1.51（95%可信区间，1.18至1.92）。对多个心血管危险因素进行额外调整后，这些关联有所减弱：分别为1.34（95%可信区间，1.08至1.67）和1.25（95%可信区间，0.98至1.58）。
本研究基于较短的随访期，提供了证据表明颈总动脉IMT增加与未来的脑血管和心血管事件相关。
