Article Text

Download PDFPDF
Original article
Combination of carotid intima-media thickness and plaque for better predicting risk of ischaemic cardiovascular events
  1. Wuxiang Xie1,
  2. Lirong Liang2,
  3. Liancheng Zhao3,
  4. Ping Shi4,
  5. Ying Yang5,
  6. Gaoqiang Xie6,
  7. Yong Huo5,
  8. Yangfeng Wu1,6
  1. 1Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
  2. 2Department of Infectious Diseases and Clinical Microbiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
  3. 3Department of Epidemiology, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China
  4. 4Department of Noncommunicable Disease, Shijingshan Center for Disease Prevention and Control, Beijing, China
  5. 5Department of Cardiology, Peking University First Hospital, Beijing, China
  6. 6Data Management Center, Peking University Clinical Research Institute, Beijing, China
  1. Correspondence to Yangfeng Wu, Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, No. 38, Xueyuan Road, Haidian District, Beijing, 100191, China; wuyf{at}


Background Several indices of carotid atherosclerosis have been studied to investigate their associations with the risk of cardiovascular disease. However, the best index of carotid atherosclerosis that predicts the risk of cardiovascular disease remains unclear.

Objective To investigate the index that best reflects the relationship between carotid atherosclerosis and subsequent ischaemic cardiovascular disease (ICVD) events.

Design An observational longitudinal study with a 5-year follow-up.

Participants 1734 Chinese subjects (623 men, 1111 women) aged 43–79 years at baseline.

Main outcome measures ICVD events, including coronary heart disease and ischaemic stroke.

Results Carotid intima-media thickness (IMT) at baseline was significantly associated with the risk of ICVD among participants without carotid plaque (multivariable adjusted HR=1.59, 95% CI 1.04 to 2.45) but not among those with plaque (HR=1.04, 95% CI 0.78 to 1.39). However, the total area of plaques (HR=1.29, 95% CI 1.08 to 1.55), the number of plaques (HR=1.14, 95% CI 1.02 to 1.27) and the number of segments with plaque (HR=1.45, 95% CI 1.09 to 1.93) were all significantly associated with ICVD in participants with plaque. Thus, carotid IMT and the number of segments with plaque were combined to establish a summary index—the total burden score (TBS) of carotid atherosclerosis—which was shown to improve the prediction of the 5-year risk of ICVD significantly compared with IMT or the number of segments with plaque alone. The c-statistics and net reclassification index showed that TBS improved the risk prediction by increases of 6.0% and 17.1%, respectively, compared with the conventional risk score.

Conclusion The TBS could significantly improve the prediction of ICVD risk and should be used in clinical practice and future studies.

  • Intima-media thickness
  • plaque
  • stroke
  • coronary heart disease
  • ischaemic cardiovascular disease
  • Chinese
  • coronary artery disease (CAD)
  • epidemiology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was supported by the People's Republic of China Ministry of Science and Technology and the Ministry of Health through the 10th and 11th National Five-Year Plan projects (contracts 2001BA703B01 and 2006BAI01A02).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The Peking University Health Science Center Ethics Committee approved the examination and follow-up in 2007 and the Cardiovascular Institute and Fuwai Hospital Ethics Committee approved all the previous studies.

  • Provenance and peer review Not commissioned; externally peer reviewed.