Risk factors and segment-specific carotid arterial enlargement in the Atherosclerosis Risk in Communities (ARIC) cohort.

BACKGROUND AND PURPOSE B-mode ultrasound imaging affords the opportunity to quantify both intimal-medial thickness (IMT) and lumen diameter of extracranial carotid arteries in ambulatory populations. Since the relation of IMT to lumen diameter may be complex, we asked whether cardiovascular disease risk factors (previously shown to be associated with greater arterial IMT) are related to smaller lumen diameters. METHODS We used B-mode ultrasound to quantify lumen diameter, interadventitial diameter, and IMT of the extracranial carotid arteries and assessed the relationship of these measures to body mass index, smoking, low-density lipoprotein (LDL) and high-density lipoprotein cholesterol, hypertension, and diabetes in 6088 male and 7493 female participants in the Atherosclerosis Risk in Communities (ARIC) cohort. RESULTS Smoking, hypertension, and LDL cholesterol were consistently related to greater IMT in the common and internal carotid arteries of men and women, as has been previously reported. In the internal carotid artery, smoking, hypertension, and LDL cholesterol were consistently related to smaller lumens. In the common carotid artery, body mass index, smoking, and hypertension were related to significantly larger, and LDL cholesterol to smaller, lumens. Thus, only LDL cholesterol was consistently associated with smaller lumens in both the common and internal carotid arteries. CONCLUSIONS Risk factors relate positively to IMT in both the common and internal carotid arteries and inversely with lumen diameter in the internal carotid artery, in parallel with their relation to clinical events. However, their association with lumen diameters of the common carotid artery in population-based samples is more complex, and in some cases adverse levels of risk factors may be associated with larger lumens.

[1]  J. Weitz,et al.  Increased neutrophil elastase activity in cigarette smokers. , 1987, Annals of internal medicine.

[2]  M L Bots,et al.  Cardiovascular Determinants of Carotid Artery Disease: The Rotterdam Elderly Study , 1992, Hypertension.

[3]  J. Salonen,et al.  Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. , 1991, Arteriosclerosis and thrombosis : a journal of vascular biology.

[4]  M. Spencer,et al.  Prevalence of Extracranial Carotid Artery Disease Detectable by Echo‐Doppler in an Elderly Population , 1992, Stroke.

[5]  W. P. Dixon,et al.  BMPD statistical software manual , 1988 .

[6]  T M Morgan,et al.  Remodeling of coronary arteries in human and nonhuman primates. , 1994, JAMA.

[7]  J. Toole,et al.  Extracranial carotid atherosclerosis in patients with and without transient ischemic attacks and coronary artery disease. , 1990, Arteriosclerosis.

[8]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[9]  S. Wolfson,et al.  Carotid and lower extremity arterial disease in elderly adults with isolated systolic hypertension. , 1987, Stroke.

[10]  Aric Invest The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators , 1989 .

[11]  J. Toole,et al.  Individual Variation in Susceptibility to Extracranial Carotid Atherosclerosis , 1988, Arteriosclerosis.

[12]  I. Ringqvist,et al.  Survival of Medically Treated Patients in the Coronary Artery Surgery Study (CASS) Registry , 1982, Circulation.

[13]  M. Nishino,et al.  Progression of carotid atherosclerosis in Japanese patients with coronary artery disease. , 1992 .

[14]  C. Furberg,et al.  Pravastatin, Lipids, and Atherosclerosis in the Carotid Arteries (PLAC-II) , 1995, The American journal of cardiology.

[15]  J. Norris,et al.  Outcome in patients with asymptomatic neck bruits. , 1986, The New England journal of medicine.

[16]  R Rauramaa,et al.  Prevalence of carotid atherosclerosis and serum cholesterol levels in eastern Finland. , 1988, Arteriosclerosis.

[17]  L. Chambless,et al.  Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study. , 1991, American journal of epidemiology.

[18]  S. Laurent,et al.  Arterial alterations with aging and high blood pressure. A noninvasive study of carotid and femoral arteries. , 1993, Arteriosclerosis and thrombosis : a journal of vascular biology.

[19]  U. Keil,et al.  B-scan ultrasound examination of the carotid arteries within a representative population (MONICA Project Augsburg). , 1988, Klinische Wochenschrift.

[20]  M. Dubick,et al.  Assessment of the role of pancreatic proteases in human abdominal aortic aneurysms and occlusive disease. , 1988, Clinica chimica acta; international journal of clinical chemistry.

[21]  J. W. Norris,et al.  Silent Stroke and Carotid Stenosis , 1992, Stroke.

[22]  R. Ross The pathogenesis of atherosclerosis: a perspective for the 1990s , 1993, Nature.

[23]  D. Hartmann,et al.  Changes in the elastic tissue of the non‐sun‐exposed skin of cigarette smokers , 1991, The British journal of dermatology.

[24]  D. Sackett,et al.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. , 1991, The New England journal of medicine.

[25]  J. Salonen,et al.  Progression of carotid atherosclerosis and its determinants: a population-based ultrasonography study. , 1990, Atherosclerosis.

[26]  J. K. Lloyd,et al.  Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis , 1992, The Lancet.

[27]  E. Rogot,et al.  Smoking and causes of death among U.S. veterans: 16 years of observation. , 1980, Public health reports.

[28]  C. Zarins,et al.  Compensatory enlargement of human atherosclerotic coronary arteries. , 1987, The New England journal of medicine.

[29]  R. Kerber,et al.  Delineation of the extent of coronary atherosclerosis by high-frequency epicardial echocardiography. , 1987, The New England journal of medicine.

[30]  M. Blue,et al.  Possible mechanisms of emphysema in cigarette smokers. Release of elastase from human polymorphonuclear leukocytes by cigarette smoke condensate in vitro. , 1978, The American review of respiratory disease.

[31]  W. Hornebeck,et al.  On the influence of the substrate (elastin) in elastase-alpha 1 antitrypsin interactions. , 1985, Pathologie-biologie.

[32]  C. Furberg,et al.  Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group. , 1994, Circulation.

[33]  L Guize,et al.  Risk factors for early carotid atherosclerosis in middle-aged French women. , 1991, Arteriosclerosis and thrombosis : a journal of vascular biology.

[34]  P. Sorlie,et al.  Arterial Enlargement in the Atherosclerosis Risk in Communities (ARIC) Cohort: In Vivo Quantification of Carotid Arterial Enlargement , 1994, Stroke.

[35]  B. Hanson,et al.  Risk factors for carotid artery stenosis: an epidemiological study of men aged 69 years. , 1991, Journal of clinical epidemiology.

[36]  J. Toole,et al.  Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study. , 1990, Circulation.

[37]  L. Klein,et al.  Intravascular ultrasound in coronary atherosclerosis: a new approach to clinical assessment. , 1992, American heart journal.

[38]  J. Travis,et al.  Kinetic and chemical evidence for the inability of oxidized alpha 1-proteinase inhibitor to protect lung elastin from elastolytic degradation. , 1984, Hoppe-Seyler's Zeitschrift fur physiologische Chemie.

[39]  W. Mack,et al.  Beneficial Effects of Colestipol‐Niacin Therapy on the Common Carotid Artery. Two‐ and Four‐Year Reduction of Intima‐Media Thickness Measured by Ultrasound , 1993, Circulation.