Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) study.
Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) study.
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DOI：
10.1093/oxfordjournals.aje.a010233
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发表时间：
2000-03
影响因子：
5
通讯作者：
L. Chambless;A. Folsom;L. Clegg;A. Sharrett;E. Shahar;F. Nieto;W. Rosamond;G. Evans
中科院分区：
文献类型：
--
作者：
L. Chambless;A. Folsom;L. Clegg;A. Sharrett;E. Shahar;F. Nieto;W. Rosamond;G. Evans
很少有研究确定颈动脉内膜-中层厚度(IMT)是否与首次缺血性卒中的风险有关。在社区动脉粥样硬化风险研究中，颈动脉内膜厚度被定义为B型超声在颈动脉六个部位测量的颈动脉内膜厚度的平均值。作者评估了美国四个社区的7,865名女性和6,349名男性的平均颈动脉内膜厚度与中风发病率的关系，这些女性和男性年龄在45-之间，基线上没有中风病史。女性发生了90起缺血性中风事件，男性发生了109起。在仅对年龄、种族和社区进行调整的性别特定的COX比例风险模型中，将极端平均IMT值(或=1 mm)与小于0.6 mm的值进行比较的风险比女性为8.5(95%可信区间：3.5，20.7)，男性为3.6(95%可信区间：1.5，9.2)。这种关系是分级的，使用三次样条法的模型显示出显著的非线性，IMTS较低的风险比IMTS较高的增加得更快。因此，使用线性IMT值的模型大大低估了较低IMT时的关联强度。这种关联的强度因纳入可能的卒中危险因素而降低，但在IMTS较高时仍较高。因此，颈动脉平均IMT是未来缺血性卒中发病率的无创性预测指标。
Few studies have determined whether carotid artery intima-media thickness (IMT) is associated prospectively with risk of first ischemic stroke. In the Atherosclerosis Risk in Communities Study, carotid IMT, an index of generalized atherosclerosis, was defined as the mean of IMT measured by B-mode ultrasonography at six sites of the carotid arteries. The authors assessed the relation of mean IMT to stroke incidence over 6-9 years' follow-up (1987-1995) among 7,865 women and 6,349 men aged 45-64 years without prior stroke at baseline in four US communities. There were 90 incident ischemic stroke events for women and 109 for men. In sex-specific Cox proportional hazards models adjusting only for age, race, and community, the hazard rate ratios comparing extreme mean IMT values (> or =1 mm) to values less than 0.6 mm were 8.5 for women (95% confidence interval: 3.5, 20.7) and 3.6 for men (95% confidence interval: 1.5, 9.2). The relation was graded, and models with cubic splines indicated significant nonlinearity, with hazards increasing more rapidly at lower IMTs than at higher IMTs. Thus, models using linear IMT values substantially underestimate the strength of the association at lower IMTs. The strength of the association was reduced by the inclusion of putative stroke risk factors, but it remained elevated at higher IMTs. Hence, mean carotid IMT is a noninvasive predictor of future ischemic stroke incidence.