Carotid intima-media thickness and carotid and/or iliofemoral plaques: comparison of two markers of cardiovascular risk in hypertensive patients.

OBJECTIVE: In order to optimize cardiovascular risk assessment, we compared the association of common carotid artery intima-media thickness (CCA-IMT) with carotid and/or iliofemoral (C/IF) plaques according to the presence or absence of cardiovascular disease (CVD) and belonging to a high cardiovascular risk group. DESIGN: The study was conducted in 323 subjects presenting one or several cardiovascular risk factors in an internal medicine hospital department; 96 patients had one or more manifestations of cardiovascular disease. RESULTS: Compared with patients with no C/IF plaques, patients with plaques at 1-4 sites presented an adjusted odds ratio (OR) [95% confidence interval] of presenting CVD of respectively [1: OR = 1.79 (0.64-5.04); 2: OR = 3.35 (1.27-8.85); 3: OR = 3.40 (1.09-10.62); 4: OR = 14.41 (3.75-55.40)]. On the other hand, the OR of CVD for 1 SD increment of CCA-IMT was: 0.95 (0.69-1.31). In the group of 199 patients, for which Framingham-based calculations of CV risks were methodologically accessible, both CCA-IMT and C/IF plaques were associated with all cardiovascular risks. Comparison of areas under receiver operating characteristic curves among association of C/IF plaques and CCA-IMT with the presence of CVD showed a statistically significant difference (0.78 +/- 0.09 versus 0.64 +/- 0.09, P < 0.001). CONCLUSION: Arterial plaques may constitute a better marker of the presence of CVD than CCA-IMT. Comparisons according to 10-year Framingham equations did not show statistical significance, but both measures seemed to be highly predictive and possibly complementary. Prospective studies are needed to confirm these findings.