Carotid arterial wall characteristics are associated with incident ischemic stroke but not coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) study

Abstract

Background and purpose: Ultrasound measurements of arterial stiffness are associated with atherosclerosis risk factors, but limited data exist on their association with incident cardiovascular events. We evaluated the association of carotid ultrasound-derived arterial stiffness measures with incident coronary heart disease (CHD) and ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) study.

Methods: Carotid arterial strain and compliance, distensibility and stiffness indices, pressure-strain, and Young elastic moduli were measured in 10 407 individuals using ultrasound. Hazard ratios for incident CHD (myocardial infarction, fatal CHD, coronary revascularization) and stroke in minimally adjusted (age, sex, center, race) and fully adjusted models (minimally adjusted model+diabetes, height, weight, total cholesterol, high-density lipoprotein cholesterol, tobacco use, systolic blood pressure, antihypertensive medication use, and carotid intima-media thickness) were calculated.

Results: The mean age was 55.3 years. Over a mean follow-up of 13.8 years, 1267 incident CHD and 383 ischemic stroke events occurred. After full adjustment for risk factors and carotid intima-media thickness, all arterial stiffness parameters (carotid arterial strain hazard ratio [HR], 1.14 [95% CI, 1.02-1.28]; arterial distensibility HR, 1.19 [1.02-1.39]; stiffness indices HR, 1.14 [1.04-1.25]; pressure-strain HR, 1.17 [1.06-1.28]; Young elastic moduli HR, 1.13 [1.03-1.24]), except arterial compliance (HR, 1.02 [0.90-1.16], were significantly associated with incident stroke but not with CHD.

Conclusions: After adjusting for cardiovascular risk factors, ultrasound measures of carotid arterial stiffness are associated with incident ischemic stroke but not incident CHD events despite that the 2 outcomes sharing similar risk factors.

Clinical trial registration: URL: www.clinicaltrials.gov. Unique identifier: NCT00005131.

Figure 1. Association of Carotid Arterial Stiffness Parameters and Incident Coronary Heart Disease

Hazard ratios for incident composite coronary heart disease events examining a one standard deviation (1-SD) difference toward adverse arterial stiffness* for each vascular wall characteristics adjusted for different covariates. Model 1 included age, gender, study site, and race; Model 2 included Model 1 covariates plus height, weight, diabetes, total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, and antihypertensive medication use; and, Model 3 included Model 2 covariates plus carotid intima-media thickness. *1-SD decrease for carotid arterial strain (CAS), arterial compliance (AC), and arterial distensibility (AD). 1-SD increase for stiffness index (SI), pressure-strain modulus (Ep), and Young’s elastic modulus (YEM).

Figure 2. Association of Carotid Arterial Stiffness Parameters and Incident Stroke

Hazard ratios for incident strokes examining a one standard deviation difference (1-SD) difference toward adverse arterial stiffness* for each vascular wall characteristics adjusted for different covariates. Model 1 included age, gender, study site, and race; Model 2 included Model 1 covariates plus height, weight, diabetes, total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, and antihypertensive medication use; and, Model 3 included Model 2 covariates plus carotid intima-media thickness. *1-SD decrease for carotid arterial strain (CAS), arterial compliance (AC), and arterial distensibility (AD). 1-SD increase for stiffness index (SI), pressure-strain modulus (Ep), and Young’s elastic modulus (YEM).