Predictive Value of Noninvasive Measures of Atherosclerosis for Incident Myocardial Infarction The Rotterdam Study

• Published in: Circulation (New York, N.Y.) Vol. 109; no. 9; pp. 1089 - 1094
• Main Authors: van der Meer, Irene M., Bots, Michiel L., Hofman, Albert, Iglesias del Sol, Antonio, van der Kuip, Deirdre A.M., Witteman, Jacqueline C.M.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 09.03.2004; American Heart Association, Inc
• Subjects: Aged; Arteriosclerosis - complications; Arteriosclerosis - diagnosis; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Incidence; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - epidemiology; Prospective Studies; Vascular disease; Myocardial infarction; coronary disease; Heart disease; Atherosclerosis; Predictive value; Cardiovascular disease; Myocardial disease; Epidemiology
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/01.CIR.0000120708.59903.1B

Background— Several noninvasive methods are available to investigate the severity of extracoronary atherosclerotic disease. No population-based study has yet examined whether differences exist between these measures with regard to their predictive value for myocardial infarction (MI) or whether a given measure of atherosclerosis has predictive value independently of the other measures. Methods and Results— At the baseline (1990–1993) examination of the Rotterdam Study, a population-based cohort study among subjects age ≥55 years, carotid plaques and intima-media thickness (IMT) were measured by ultrasound, abdominal aortic atherosclerosis by x-ray, and lower-extremity atherosclerosis by computation of the ankle-arm index. In the present study, 6389 subjects were included; 258 cases of incident MI occurred before January 1, 2000. All 4 measures of atherosclerosis were good predictors of MI independently of traditional cardiovascular risk factors. Hazard ratios were equally high for carotid plaques (1.83 [1.27 to 2.62], severe versus no atherosclerosis), carotid IMT (1.95 [1.19 to 3.19]), and aortic atherosclerosis (1.94 [1.30 to 2.90]) and slightly lower for lower-extremity atherosclerosis (1.59 [1.05 to 2.39]), although differences were small. The hazard ratio for MI for subjects with severe atherosclerosis according to a composite atherosclerosis score was 2.77 (1.70 to 4.52) compared with subjects with no atherosclerosis. The predictive value of MI for a given measure of atherosclerosis was independent of the other atherosclerosis measures. Conclusions— Noninvasive measures of extracoronary atherosclerosis are strong predictors of MI. The relatively crude measures directly assessing plaques in the carotid artery and abdominal aorta predict MI equally well as the more precisely measured carotid IMT.