Original Article

Subclinical Atherosclerosis Among Young and Middle-Aged Adults Using Carotid Intima-Media Thickness Measurements

Authors: Deborah L. Jones, PhD, MEd, Violeta J. Rodriguez, MSEd, Maria L. Alcaide, MD, Nicole Barylski, HS, Digna Cabral, BS, Tatjana Rundek, MD, PhD, Stephen M. Weiss, PhD, MPH, Mahendra Kumar, PhD


Objectives: The presence of atherosclerotic plaque in the carotid arteries is a strong predictor of cardiovascular disease (CVD). Research and data on CVD risk have been derived primarily from individuals aged 55 years or older, and assessment of CVD risk among young and middle-aged adults seldom has been studied. The use of ultrasonography to measure carotid intima-media thickness (IMT) and carotid plaque appears to have utility to detect subclinical atherosclerosis in asymptomatic adults. This study evaluated the presence of carotid plaque using ultrasonography among healthy young and middle-aged adults.

Methods: Participants were men and women recruited in Miami, Florida, and were 18 to 50 years old with no history of CVD. Participants underwent a general physical examination and carotid artery ultrasonography to evaluate carotid IMT and carotid plaque.

Results: From a total of 173 participants with a mean age of 34 years (standard deviation 8.9), 21.0% (95% confidence interval [CI] 15.0–27.2) were identified as having carotid plaque. IMT values ranged from 0.49 to 1.03 mm, with a mean value of 0.70 mm (standard deviation 0.09). In multivariable logistic regression older age (adjusted odds ratio [AOR] 1.08, 95% CI 1.01–1.16, P = 0.024) and cigarette smoking (AOR 2.67, 95% CI 1.02–7.00, P = 0.045) were associated with plaque, after controlling for IMT (AOR 2.55, 95% CI 1.40–4.65, P = 0.002).

Conclusions: Traditional CVD risk factors such as those evaluated in this study may fail to provide adequate predictive value of carotid atherosclerosis in younger populations with no history of CVD, because the majority of traditional risk factors identified in previous research were not associated with carotid plaque in this young sample. Further research assessing nontraditional risk factors among asymptomatic individuals is required, and the evaluation of IMT as an intervention tool to detect CVD risk in these asymptomatic populations is warranted.

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1. World Health Organization. Global atlas on cardiovascular disease prevention and control. http://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en. Published 2011. Accessed August 24, 2017.
2. Kesse-Guyot E, Vergnaud AC, Fezeu L, et al. Associations between dietary patterns and arterial stiffness, carotid artery intima-media thickness and atherosclerosis. Eur J Cardiov Prev Rehabil 2010;17:718-724.
3. Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012;34:290-296.
4. Breton CV, Wang X, Mack WJ, et al. Carotid artery intima-media thickness in college students: race/ethnicity matters. Atherosclerosis 2011;217:441-446.
5. Eikendal AL, Groenewegen KA, Anderson TJ, et al. Common carotid intima-media thickness relates to cardiovascular events in adults aged <45 years. Hypertension 2015;65:707-713.
6. Oh J, Wunsch R, Turzer M, et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 2002;106:100-105.
7. Oren A, Vos LE, Uiterwaal CS, et al. Cardiovascular risk factors and increased carotid intima-media thickness in healthy young adults: the Atherosclerosis Risk in Young Adults (ARYA) Study. Arch Intern Med 2003;163:1787-1792.
8. Homma S, Hirose N, Ishida H, et al. Carotid plaque and intima-media thickness assessed by b-mode ultrasonography in subjects ranging from young adults to centenarians. Stroke 2001;32:830-835.
9. Laitinen T. Cardiovascular health from childhood to adulthood-with special reference to early vascular changes. The Cardiovascular Risk in Young Finns Study. https://www.doria.fi/bitstream/handle/10024/104430/AnnalesD%201174Laitinen.pdf?sequence=2. Published 2015. Accessed August 24, 2017.
10. Puttonen S, Kivimaki M, Elovainio M, et al. Shift work in young adults and carotid artery intima-media thickness: the Cardiovascular Risk in Young Finns study. Atherosclerosis 2009;205:608-613.
11. Tattersall MC, Gassett A, Korcarz CE, et al. Predictors of carotid thickness and plaque progression during a decade: the Multi-Ethnic Study of Atherosclerosis. Stroke 2014;45:3257-3262.
12. Sacco RL, Roberts JK, Boden-Albala B, et al. Race-ethnicity and determinants of carotid atherosclerosis in a multiethnic population. The Northern Manhattan Stroke Study. Stroke 1997;28:929-935.
13. Polak JF, Tracy R, Harrington A, et al. Carotid artery plaque and progression of coronary artery calcium: the multi-ethnic study of atherosclerosis. J Am Soc Echocardiogr 2013;26:548-555.
14. Hartiala O, Magnussen CG, Kajander S, et al. Adolescence risk factors are predictive of coronary artery calcification at middle age: the cardiovascular risk in young Finns study. J Am Coll Cardiol 2012;60:1364-1370.
15. Berenson GS, Srinivasan SR, Bao W, et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998;338:1650-1656.
16. Sillesen H, Muntendam P, Adourian A, et al. Carotid plaque burden as a measure of subclinical atherosclerosis: comparison with other tests for subclinical arterial disease in the High Risk Plaque BioImage study. JACC Cardiovasc Imaging 2012;5:681-689.
17. Toth PP. Subclinical atherosclerosis: what it is, what it means and what we can do about it. Int J Clin Pract 2008;62:1246-1254.
18. Reynolds SJ, Muwonga J. OraQuick ADVANCE Rapid HIV-1/2 antibody test. Expert Rev Mol Diagn 2004;4:587-591.
19. Craig CL, Marshall AL, Sjostrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sport Exer 2003;35:1381-1395.
20. MacAuley D, Bauman AE, Frémont P. Exercise: not a miracle cure, just good medicine. Br J Sports Med 2016;50:1107-1108.
21. Gans KM, Risica PM, Wylie-Rosett J, et al. Development and evaluation of the nutrition component of the Rapid Eating and Activity Assessment for Patients (REAP): a new tool for primary care providers. J Nutr Educ Behav 2006;38:286-292.
22. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;1:385-401.
23. Costa RA, Reiber JH, Rybicki FJ, et al. Cardiovascular imaging 2010 in the International Journal of Cardiovascular Imaging. Int J Cardiovasc Imaging 2011;27:309-319.
24. Santos IS, Bittencourt MS, Oliveira IR, et al. Carotid intima-media thickness value distributions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Atherosclerosis 2014;237:227-235.
25. Boulos NM, Gardin JM, Malik S, et al. Carotid plaque characterization, stenosis, and intima-media thickness according to age and gender in a large registry cohort. Am J Cardiol 2016;117:1185-1191.
26. Pursnani S, Diener-West M, Sharrett AR. The effect of aging on the association between coronary heart disease risk factors and carotid intima media thickness: an analysis of the Atherosclerosis Risk in Communities (ARIC) cohort. Atherosclerosis 2014;233:441-446.
27. Dong C, Cabral D, Marquez C, et al. Segment-specific association of body mass index with carotid plaque and intima-media thickness: the Northern Manhattan Study. Arterioscler Thromb Vasc Biol 2012;32( Suppl 1 ):A38-A38.
28. Martinsson A, Ostling G, Persson M, et al. Carotid plaque, intima-media thickness, and incident aortic stenosis: a prospective cohort study. Arterioscler Thromb Vasc Biol 2014;34:2343-2348.
29. Alsulaimani S, Gardener H, Elkind MS, et al. Elevated homocysteine and carotid plaque area and densitometry in the Northern Manhattan Study. Stroke 2013;44:457-461.
30. Dawber TR, Meadors GF, Moore FE, Jr. Epidemiological approaches to heart disease: the Framingham Study. Am J Public Health Nations Health 1951;41:279-281.
31. Rundek T, Gardener H, Della-Morte D, et al. The relationship between carotid intima-media thickness and carotid plaque in the Northern Manhattan Study. Atherosclerosis 2015;241:364-370.
32. Mosca L, Barrett-Connor E, Wenger NK. Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation 2011;124:2145-2154.
33. Khalil A, Huffman MD, Prabhakaran D, et al. Predictors of carotid intima-media thickness and carotid plaque in young Indian adults: the New Delhi birth cohort. Int J Cardiol 2013;167:1322-1328.
34. Bahrami H, Kronmal R, Bluemke DA, et al. Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis. Arch Intern Med 2008;168:2138-2145.
35. Masiá M, Bernal E, Padilla S, et al. A pilot randomized trial comparing an intensive versus a standard intervention in stable HIV-infected patients with moderate-high cardiovascular risk. J Antimicrob Chemother 2009;64:589-98.
36. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. New York:Guilford Press;2012.
37. Greenland P, LaBree L, Azen SP, et al. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004;291:210-215.
38. Carpenter M, Sinclair H, Kunadian V. Carotid intima media thickness and its utility as a predictor of cardiovascular disease: a review of evidence. Cardiol Rev 2016;24:70-75.
39. Tiozzo E, Gardener H, Hudson BI, et al. High-density lipoprotein subfractions and carotid plaque: the Northern Manhattan Study. Atherosclerosis 2014;237:163-168.