Elsevier

Atherosclerosis

Volume 218, Issue 2, October 2011, Pages 344-349
Atherosclerosis

Associations of cardiovascular risk factors, carotid intima-media thickness and left ventricular mass with inter-adventitial diameters of the common carotid artery: The Multi-Ethnic Study of Atherosclerosis (MESA)

https://doi.org/10.1016/j.atherosclerosis.2011.05.033Get rights and content

Abstract

Background

Common carotid artery inter-adventitial diameter (IAD) and intima-media thickness (IMT) are measurable by ultrasound. IAD may be associated with left ventricular mass (LV mass) while IMT is a marker of subclinical atherosclerosis. It is not clear if IAD is associated with LV mass after accounting for IMT and traditional cardiovascular risk factors.

Methods

IAD and IMT were measured on participants of the Multi-Ethnic Study of Atherosclerosis (MESA) IMT progression study. A total of 5641 of the originally enrolled 6814 MESA participants were studied. LV mass was measured by magnetic resonance imaging. Multivariable linear regression was used with IAD as the outcome and adjustment for risk factors, as well as IMT and LV mass.

Results

Traditional cardiovascular risk factors, height, weight and ethnicity were significantly associated with IAD. After adjustment for risk factors, a 1 mm difference in IMT was associated with a 1.802 mm (95% CI: 1.553, 2.051) higher mean IAD. A 1 g difference in LV mass was associated with a 0.006 mm (95% CI: 0.005, 0.007) higher mean IAD. After adjusting for cardiovascular risk factors and IMT, a 1 g difference in LV mass was associated with a 0.006 mm (95% CI: 0.005, 0.008) higher mean IAD for women and 0.004 mm (95% CI: 0.003, 0.005) higher IAD for men.

Conclusions

Inter-adventitial diameters are associated with left ventricular mass after adjusting for cardiovascular risk factors and IMT. IAD might serve as a surrogate for left ventricular mass and have predictive value for cardiovascular outcomes.

Highlights

► Intima-media thickness (IMT) of the carotid artery is a marker of atherosclerosis. ► Left ventricular mass is a marker of the effects of blood pressure exposure. ► Carotid artery diameter is easily measured with a non-invasive ultrasound study. ► Carotid artery diameter is associated with IMT and left ventricular mass

Introduction

The increase in diameter of the coronary and carotid arteries that occurs in response to the deposition of atherosclerotic plaque is referred to as the Glagov phenomenon [1]. This adaptive response is therefore directly linked to the atherosclerotic process.

Arterial diameters also increase as blood pressure increases [2], [3], [4], [5]. Increases in left ventricular mass (LV mass) are associated with chronic blood pressure elevation [6] and with larger common carotid artery lumen diameters as well as external (adventitia to adventitia) diameters [7], [8].

Inter-adventitial diameter (IAD) of the carotid artery is non-invasively measured with ultrasound. IAD is a combination of the lumen diameter and of IMT and has been shown to be associated with carotid artery intima-media thickness (IMT) and blood pressure [2], [3], [4], [9], [10] while there are no data confirming an association with LV mass. If present, the association between IAD and LV mass might be weakened by taking into consideration traditional cardiovascular risk factors, height, weight given the presence of subclinical disease measured as carotid artery IMT since IMT is implicitly part of the IAD measurement.

We hypothesize that IAD is independently associated with LV mass and that IAD might be a marker of elevated LV mass after accounting for IMT and traditional risk factors. We study these possibilities in participants of a multi-ethnic cohort: the Multi-Ethnic Study of Atherosclerosis (MESA).

Section snippets

Population

MESA recruited and examined a multiethnic population of 6814 men and women aged 45–84 with no history of clinical cardiovascular disease [11]. The MESA cohort is composed of white, African-American, Hispanic-American, and Chinese participants. Participants were excluded if they had physician diagnosis of myocardial infarction, stroke, transient ischemic attack, heart failure, angina, atrial fibrillation or history of any cardiovascular procedure, weight above 300 lbs, pregnancy, or any medical

Results

Baseline demographics are summarized in Table 1. Of the 5641 subjects studied, 52% were female, while African-Americans formed 26% of the group, Chinese 12%, Hispanic 22% and the rest were Caucasian (40%).

Key associations between IAD and cardiovascular risk factors are shown in Table 2. For unadjusted analyses, positive associations with IAD were seen for age, male gender, height and weight, lipid-lowering medication use, all diabetes categories (treated diabetes, untreated diabetes, impaired

Discussion

We have found significant associations between inter-adventitial diameters of the common carotid artery and LV mass after adjustment for traditional cardiovascular risk factors, height, weight and IMT. These associations are slightly different in separate analyses performed for men and women.

Our findings cast some insight into the associations between subclinical atherosclerosis and carotid artery diameters and extend the findings to a multi-ethnic cohort. We show a positive association between

Conclusions

We have shown that the inter-adventitial diameter of the common carotid artery is associated with left ventricular mass after taking into consideration cardiovascular risk factors and IMT. This observation suggests that the inter-adventitial diameter of the common carotid artery might have predictive value for certain cardiovascular events by acting as a marker of increased left ventricular mass.

Disclosures

Daniel H. O’Leary owns stock in Medpace, Inc.

Acknowledgements

The authors would like to thank the investigators, the staff, and the participants of the Multi-Ethnic Study of Atherosclerosis, MESA for their valuable contributions. This research was supported by Contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95167 as well as R01 HL069003 and R01 HL081352.

A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. This study is registered at ClinicalTrials.gov as #NCT00063440.

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