CAROTID ARTERY FOLLOW UP STUDY (CAFUS)

病例对照研究揭示了颅外颈动脉内膜中层增厚（ECIMT）和冠状动脉疾病（CAD）的血管造影证据之间的强相关性。 还观察到ECIMT程度与CAD程度之间存在强相关性，重度ECIMT患者发生冠心病的风险增加。 在有和没有CAD的患者中，ECIMT与年龄相关的横断面数据表明，CAD患者处于ECIMT进展的“快车道”。 这项纵向研究的目的之一是确定与无CAD对照相比，CAD患者快速进展的印象是否正确，并量化总体效应的大小以及男性和女性中的节段特异性效应，因为它受到基线风险因素和基线ECIMT的影响。 ECIMT的快速进展是否导致管腔直径减小尚不清楚。 我们最近的研究表明（颅外）动脉的管腔和内膜中层厚度之间存在复杂的关系。 这项研究还将使我们能够量化患有和不患有CAD的男性和女性的动脉尺寸的时间变化以及CAD风险因素、基线ECIMT和基线动脉尺寸对他们的影响。 我们将测试的具体假设是：1）。ECIMT在具有CAD和/或CAD风险因素的男性和女性中比在无CAD/风险因素的对照中进展更快;进展与基线风险因素和基线ECIMT相关，但CAD患者即使在控制这些因素后也具有更快的进展; 2.）CAD患者ECIMT进展更快与颈内动脉管腔更快变窄相关，但与颈总动脉管腔不相关;基线风险因素和基线ECIMT仅部分解释了该效应。 具体目标是1.）在先前访问的280名患有和不患有CAD的志愿者的队列中获得ECIMT的3年进展率，并使用多变量分析将登记状态与进展率相关联; 2.）量化该队列中的基线管腔直径，并将其与ECIMT、风险因素和CAD状态相关联;量化该队列中3年内颈总动脉和颈内动脉管腔狭窄所反映的疾病进展。 已经访问了特定目标I和II的患者，并正在对其进行随访：本提案仅要求完成最后一年的随访和分析。 最近的试验数据为该项目的可行性提供了依据和支持。 结果将首次量化有无CAD患者的ECIMT进展，首次定义动脉尺寸与风险因素、ECIMT和CAD的相关性，以及动脉尺寸变化与风险因素、ECIMT和CAD的相关性。

Case control studies have disclosed a strong association between extracranial carotid intimal-medial thickening (ECIMT) and angiographic evidence of coronary artery disease (CAD). A strong association between extent of ECIMT and extent of CAD has also been observed, and patients with severe ECIMT are at increased risk for incident coronary heart disease. Cross sectional data relating ECIMT to age in patients with and without CAD suggest that patients with CAD are on a "fast track" for progression of ECIMT. One purpose of this longitudinal study is to determine whether the impression of rapid progression in patients with CAD compared to CAD free controls is correct and to quantify the magnitude of the effect overall as well as the segment specific effect in men and women and as it is influenced by baseline risk factors and baseline ECIMT. Whether rapid progression of ECIMT leads to reduction of lumen diameter or not is unknown. Our recent research indicates a complex relationship between the lumen and the intima-media thickness of (extracranial) arteries. This research will also allow us to quantify the temporal change in arterial dimensions in men and women with and without CAD and the influence on them of CAD risk factors, baseline ECIMT, and baseline arterial dimensions. SPECIFIC HYPOTHESES we will test are: 1.) ECIMT progresses more rapidly in males and females with CAD and/or CAD risk factors than in CAD/risk factor free controls; progression is related to baseline risk factors and baseline ECIMT, but CAD patients have more rapid progression even after control for these factors; 2.) more rapid progression of ECIMT in CAD patients is associated with more rapid narrowing of the lumen of the internal carotid but not of the common carotid artery; this effect is only partly explained by baseline risk factors and baseline ECIMT. SPECIFIC AIMS are 1.) to obtain 3-year progression rates of ECIMT in a previously accessed cohort of 280 volunteers with and without CAD and use multivariable analysis to relate accession status to progression rate; 2.) to quantify baseline lumen diameter in this cohort and relate it to ECIMT, risk factors, and CAD status; to quantify progression of disease as reflected in narrowing of the lumen of the common and internal carotid arteries over 3 years in this cohort. Patients for SPECIFIC AIMs I and II have already been accessed and are being followed: only completion of the final year of follow-up and analysis is requested as part of this proposal. Recent pilot data provide rationale for and support the feasibility of this project. Results will provide the first quantification of progression of ECIMT in patients with and without CAD, the first definition of associations of arterial dimensions with risk factors, ECIMT, and CAD and of change in arterial dimensions with risk factors, ECIMT, and CAD.