Increased carotid artery intimal-medial thickness in asymptomatic older subjects with exercise-induced myocardial ischemia

Yoji Nagai, E. Metter, Christopher J. Earley, Mary K. Kemper, Lewis C. Becker, Edward G. Lakatta, Jerome L. Fleg

Research output: Contribution to journalArticle

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Abstract

Background - Previous studies have shown an association between symptomatic coronary artery disease (CAD) and increased intimal-medial thickness of the common carotid artery (CCA IMT), a purported index of atherosclerosis. This study determines whether CCA IMT is increased in asymptomatic older subjects with an ischemic ST-segment response to treadmill exercise. Methods and Results - CA IMT was measured by B-mode ultrasound in community-dwelling volunteers from the Baltimore Longitudinal Study of Aging, including 397 healthy subjects (age, 58.5±15.8 years) with normal ECG responses to maximum treadmill exercise, 72 asymptomatic subjects (age, 66.1 ± 13.4 years) with exercise-induced horizontal or downsloping ST-segment depression ≥1 mm, and 38 subjects (age, 77.4±7.8 years) with clinically manifest CAD as diagnosed by medical history and resting ECG. Forty-three subjects with abnormal exercise ECGs also underwent exercise thallium scintigraphy. Exercise-induced ST-segment depression was associated with increased IMT (P<0.0001) independent of age and manifest CAD. After adjustment for age, IMT values progressively increased from healthy subjects to asymptomatic subjects with positive exercise ECG alone to those with concordant positive ECG and thallium scintigraphic findings who had virtually identical IMT to subjects with manifest CAD. Each 0.1-mm increase in IMT was associated with a 1.91-fold (95% CI, 1.46 to 2.50; P<0.0001) increased risk for concordant positive exercise tests or manifest CAD, independent of other significant predictors of CAD. Conclusions - CCA IMT is increased in older subjects with asymptomatic myocardial ischemia as evidenced by exercise ECG alone or in combination with thallium scan. Carotid ultrasound may help to identify asymptomatic individuals with CAD.

Original languageEnglish (US)
Pages (from-to)1504-1509
Number of pages6
JournalCirculation
Volume98
Issue number15
DOIs
StatePublished - Oct 13 1998
Externally publishedYes

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Tunica Intima
Carotid Arteries
Myocardial Ischemia
Coronary Artery Disease
Exercise
Electrocardiography
Thallium
Healthy Volunteers
Independent Living
Baltimore
Common Carotid Artery
Exercise Test
Radionuclide Imaging
Longitudinal Studies
Volunteers
Atherosclerosis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Increased carotid artery intimal-medial thickness in asymptomatic older subjects with exercise-induced myocardial ischemia. / Nagai, Yoji; Metter, E.; Earley, Christopher J.; Kemper, Mary K.; Becker, Lewis C.; Lakatta, Edward G.; Fleg, Jerome L.

In: Circulation, Vol. 98, No. 15, 13.10.1998, p. 1504-1509.

Research output: Contribution to journalArticle

Nagai, Yoji ; Metter, E. ; Earley, Christopher J. ; Kemper, Mary K. ; Becker, Lewis C. ; Lakatta, Edward G. ; Fleg, Jerome L. / Increased carotid artery intimal-medial thickness in asymptomatic older subjects with exercise-induced myocardial ischemia. In: Circulation. 1998 ; Vol. 98, No. 15. pp. 1504-1509.
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abstract = "Background - Previous studies have shown an association between symptomatic coronary artery disease (CAD) and increased intimal-medial thickness of the common carotid artery (CCA IMT), a purported index of atherosclerosis. This study determines whether CCA IMT is increased in asymptomatic older subjects with an ischemic ST-segment response to treadmill exercise. Methods and Results - CA IMT was measured by B-mode ultrasound in community-dwelling volunteers from the Baltimore Longitudinal Study of Aging, including 397 healthy subjects (age, 58.5±15.8 years) with normal ECG responses to maximum treadmill exercise, 72 asymptomatic subjects (age, 66.1 ± 13.4 years) with exercise-induced horizontal or downsloping ST-segment depression ≥1 mm, and 38 subjects (age, 77.4±7.8 years) with clinically manifest CAD as diagnosed by medical history and resting ECG. Forty-three subjects with abnormal exercise ECGs also underwent exercise thallium scintigraphy. Exercise-induced ST-segment depression was associated with increased IMT (P<0.0001) independent of age and manifest CAD. After adjustment for age, IMT values progressively increased from healthy subjects to asymptomatic subjects with positive exercise ECG alone to those with concordant positive ECG and thallium scintigraphic findings who had virtually identical IMT to subjects with manifest CAD. Each 0.1-mm increase in IMT was associated with a 1.91-fold (95{\%} CI, 1.46 to 2.50; P<0.0001) increased risk for concordant positive exercise tests or manifest CAD, independent of other significant predictors of CAD. Conclusions - CCA IMT is increased in older subjects with asymptomatic myocardial ischemia as evidenced by exercise ECG alone or in combination with thallium scan. Carotid ultrasound may help to identify asymptomatic individuals with CAD.",
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AU - Metter, E.

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AU - Kemper, Mary K.

AU - Becker, Lewis C.

AU - Lakatta, Edward G.

AU - Fleg, Jerome L.

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N2 - Background - Previous studies have shown an association between symptomatic coronary artery disease (CAD) and increased intimal-medial thickness of the common carotid artery (CCA IMT), a purported index of atherosclerosis. This study determines whether CCA IMT is increased in asymptomatic older subjects with an ischemic ST-segment response to treadmill exercise. Methods and Results - CA IMT was measured by B-mode ultrasound in community-dwelling volunteers from the Baltimore Longitudinal Study of Aging, including 397 healthy subjects (age, 58.5±15.8 years) with normal ECG responses to maximum treadmill exercise, 72 asymptomatic subjects (age, 66.1 ± 13.4 years) with exercise-induced horizontal or downsloping ST-segment depression ≥1 mm, and 38 subjects (age, 77.4±7.8 years) with clinically manifest CAD as diagnosed by medical history and resting ECG. Forty-three subjects with abnormal exercise ECGs also underwent exercise thallium scintigraphy. Exercise-induced ST-segment depression was associated with increased IMT (P<0.0001) independent of age and manifest CAD. After adjustment for age, IMT values progressively increased from healthy subjects to asymptomatic subjects with positive exercise ECG alone to those with concordant positive ECG and thallium scintigraphic findings who had virtually identical IMT to subjects with manifest CAD. Each 0.1-mm increase in IMT was associated with a 1.91-fold (95% CI, 1.46 to 2.50; P<0.0001) increased risk for concordant positive exercise tests or manifest CAD, independent of other significant predictors of CAD. Conclusions - CCA IMT is increased in older subjects with asymptomatic myocardial ischemia as evidenced by exercise ECG alone or in combination with thallium scan. Carotid ultrasound may help to identify asymptomatic individuals with CAD.

AB - Background - Previous studies have shown an association between symptomatic coronary artery disease (CAD) and increased intimal-medial thickness of the common carotid artery (CCA IMT), a purported index of atherosclerosis. This study determines whether CCA IMT is increased in asymptomatic older subjects with an ischemic ST-segment response to treadmill exercise. Methods and Results - CA IMT was measured by B-mode ultrasound in community-dwelling volunteers from the Baltimore Longitudinal Study of Aging, including 397 healthy subjects (age, 58.5±15.8 years) with normal ECG responses to maximum treadmill exercise, 72 asymptomatic subjects (age, 66.1 ± 13.4 years) with exercise-induced horizontal or downsloping ST-segment depression ≥1 mm, and 38 subjects (age, 77.4±7.8 years) with clinically manifest CAD as diagnosed by medical history and resting ECG. Forty-three subjects with abnormal exercise ECGs also underwent exercise thallium scintigraphy. Exercise-induced ST-segment depression was associated with increased IMT (P<0.0001) independent of age and manifest CAD. After adjustment for age, IMT values progressively increased from healthy subjects to asymptomatic subjects with positive exercise ECG alone to those with concordant positive ECG and thallium scintigraphic findings who had virtually identical IMT to subjects with manifest CAD. Each 0.1-mm increase in IMT was associated with a 1.91-fold (95% CI, 1.46 to 2.50; P<0.0001) increased risk for concordant positive exercise tests or manifest CAD, independent of other significant predictors of CAD. Conclusions - CCA IMT is increased in older subjects with asymptomatic myocardial ischemia as evidenced by exercise ECG alone or in combination with thallium scan. Carotid ultrasound may help to identify asymptomatic individuals with CAD.

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