Arterial Enlargement in the Atherosclerosis Risk in Communities (ARIC) Cohort: In Vivo Quantification of Carotid Arterial Enlargement

Background and Purpose The relation between arterial wall (intimal‐medial) thickness and lumen narrowing is complex and has previously been studied predominantly at autopsy. B‐mode ultrasound affords the opportunity to visualize both wall and lumen of the extracranial carotid arteries in vivo. Several studies have quantified the relation of various independent variables to wall thickness of carotid arteries in population‐based samples, but the relation of age and wall thickness to interadventitial and lumen diameter has not previously been investigated in these samples. Methods We used B‐mode ultrasound to quantify the relation of arterial lumen diameter to age, arterial wall thickness, and arterial size (interadventitial diameter) of the extracranial carotid artery in 13 711 members of the Atherosclerosis Risk in Communities (ARIC) cohort. Results Men had greater interadventitial diameters, thicker walls, and wider lumens than women. Wall thicknesses of the common carotid artery were greater by 21% in men and 22% in women aged 60 to 64 years compared with those aged 45 to 49 years (P<.001). However, lumen diameters were also greater in older individuals because interadventitial diameters were greater. Wall thickness of the internal carotid artery was also associated positively with age, but the lumen diameter of the internal carotid artery was smaller in older individuals. Diameters of the carotid artery segments also differed in their relation to arterial wall thickening. The lumen of the internal carotid artery was uniformly progressively narrower with increasing wall thickness. For the common carotid artery greater wall thickness bore only a small correlation with narrower lumen diameter for thickening of the arterial wall up to 1.2 mm, but the association was more marked for the range of thicknesses between 1.2 mm and 2.5 mm. Conclusions When arterial enlargement accompanies increased wall thickness, less lumen constriction results than expected. Quantification of these complex relations in vivo may provide new insight into the pathogenesis of symptoms related to vascular disease. Narrowing of the internal carotid artery lumen associated with thicker walls is consistent with the observation that stenosis develops in this region and often leads to symptoms. (Stroke. 1994;25:1354‐1359.)

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

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

[3]  J. Toole,et al.  Evaluation of a scoring system for extracranial carotid atherosclerosis extent with B-mode ultrasound. , 1986, Stroke.

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

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

[6]  D. Ku,et al.  Hemodynamics and atherosclerosis. Insights and perspectives gained from studies of human arteries. , 1988, Archives of pathology & laboratory medicine.

[7]  J. Salonen,et al.  Association of serum low density lipoprotein cholesterol, smoking and hypertension with different manifestations of atherosclerosis. , 1990, International journal of epidemiology.

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

[9]  Edmind N. Coedry A SURVEY OF THE PROBLEM , 1934 .

[10]  R S Reneman,et al.  Flow velocity patterns in and distensibility of the carotid artery bulb in subjects of various ages. , 1985, Circulation.

[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]  W Riley,et al.  Risk factors and segment-specific carotid arterial enlargement in the Atherosclerosis Risk in Communities (ARIC) cohort. , 1996, Stroke.

[14]  A. Bruschke,et al.  Clinical Course of Patients with Normal, and Slightly or Moderately Abnormal Coronary Arteriograms: A Follow‐up Study on 500 Patients , 1973, Circulation.

[15]  Gerardo Heiss,et al.  Carotid Artery Intimal‐Medial Thickness Distribution in General Populations As Evaluated by B‐Mode Ultrasound , 1993, Stroke.

[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]  D. Heath,et al.  The atherosclerotic human carotid sinus. , 1973, The Journal of pathology.

[19]  C. Warlow,et al.  MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis , 1991, The Lancet.

[20]  George Howard,et al.  High‐resolution B‐Mode Ultrasound Scanning Methods in the Atherosclerosis Risk in Communities Study (ARIC) , 1991, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[21]  Ralph G. Dacey,et al.  Carotid Endarterectomy and Prevention of Cerebral Ischemia in Symptomatic Carotid Stenosis , 1991 .

[22]  M. Laakso,et al.  Asymptomatic atherosclerosis and insulin resistance. , 1991, Arteriosclerosis and thrombosis : a journal of vascular biology.

[23]  Stehbens We,et al.  Hemodynamics and atherosclerosis. , 1982, Biorheology.

[24]  M. Bond,et al.  A study of atherosclerosis regression in Macaca mulatta. I. Design of experiment and lesion induction. , 1979, Experimental and molecular pathology.

[25]  A. Folsom,et al.  The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. , 1989, American journal of epidemiology.

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

[27]  M. Bond,et al.  A study of atherosclerosis regression in Macaca mulatta. IV. Changes in coronary arteries from animals with atherosclerosis induced for 19 months and then regressed for 24 or 48 months at plasma cholesterol concentrations of 300 or 200 mg/dl. , 1981, Experimental and molecular pathology.

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

[29]  T. Pearson Coronary arteriography in the study of the epidemiology of coronary artery disease. , 1984, Epidemiologic reviews.

[30]  L. Chambless,et al.  High‐Resolution B‐Mode Ultrasound Reading Methods in the Atherosclerosis Risk in Communities (ARIC) Cohort , 1991, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[31]  G. Sicard MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or mild (0–29%) carotid stenosis: European Carotid Surgery Trialist' Collaborative Group. Lancet 1991;337:1235-43 , 1992 .

[32]  W. Santamore,et al.  Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? , 1988, Circulation.

[33]  J. Cooke,et al.  Vascular Biology and Medicine in the 1990s: Scope, Concepts, Potentials, and Perspectives , 1993, Circulation.

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

[35]  J. Salonen,et al.  Autoantibody against oxidised LDL and progression of carotid atherosclerosis , 1992, The Lancet.

[36]  E. V. Cowdry,et al.  Arteriosclerosis : a survey of the problem , 1933 .

[37]  S. Thanikachalam,et al.  Selective cine coronary arteriography. , 1971, Journal of Association of Physicians of India.

[38]  E L Bolson,et al.  Incomplete lysis of thrombus in the moderate underlying atherosclerotic lesion during intracoronary infusion of streptokinase for acute myocardial infarction: quantitative angiographic observations. , 1986, Circulation.

[39]  W. Proudfit,et al.  Selective Cine Coronary Arteriography: Correlation with Clinical Findings in 1,000 Patients , 1966, Circulation.

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

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

[42]  T. Jensen,et al.  MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists' Collaborative Group , 1991 .

[43]  W. Stehbens Hemodynamics and atherosclerosis. , 1982, Biorheology.