Carotid Intima-media thickness, carotid distensibility and incident heart failure in older men: The British Regional Heart Study

Objectives Carotid intima-media thickness (CIMT) and carotid distensibility are markers of arterial change, however little is known of the prognostic value in incident HF. We aimed to assess this prospective association. Design Longitudinal analysis of data from the British Regional Heart Study, a prospective cohort study Participants 1069 men aged 71-92 years, without a diagnosis of heart failure or myocardial infarction (MI) at baseline. Methods Between 2010-2012, participants completed a questionnaire, underwent a physical examination, and provided a fasting blood sample. CIMT and carotid artery distension were measured and carotid distensibility was calculated. Cox proportional hazards modelling was used to assess the multivariate-adjusted hazard ratios of incident HF by quartiles of CIMT and distensibility. Results Adjusted for age, social class, smoking, physical activity, alcohol status, BMI, use of statins and antihypertensives, prevalent diabetes mellitus and stroke, pulse pressure, and presence of atrial arrhythmias, lower carotid distensibility was associated with increased risk of incident HF (HR 2.55, 95% CI 1.24 to 5.24, p=0.01). The association persisted after further adjustment for CIMT and incident MI (HR 2.53, 95% CI 1.23 to 5.22, p=0.01). Higher CIMT was associated with increased risk of incident HF (HR 2.20, 95% CI 1.14 to 4.23, p=0.02). However, this was attenuated after adjustment for both CIMT and incident MI (HR 1.64, 95% CI 0.84 to 3.21, p=0.1). Conclusions Low carotid artery distensibility, but not high carotid intima-media thickness (CIMT), was associated with an increased risk of incident heart failure, independent of the development of myocardial infarction.