Response to Letter Regarding Article, “Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness: A Systematic Review and Meta-Analysis”

We 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 …