University of Oulu

Karri Parkkila, Antti Kiviniemi, Mikko Tulppo, Juha Perkiömäki, Y. Antero Kesäniemi, Olavi Ukkola, Abdominal aorta plaques are better in predicting future cardiovascular events compared to carotid intima-media thickness: A 20-year prospective study, Atherosclerosis, Volume 330, 2021, Pages 36-42, ISSN 0021-9150,

Abdominal aorta plaques are better in predicting future cardiovascular events compared to carotid intima-media thickness : a 20-year prospective study

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Author: Parkkila, Karri1; Kiviniemi, Antti1; Tulppo, Mikko2;
Organizations: 1Medical Research Center Oulu, Oulu University Hospital, Research Unit of Internal Medicine, University of Oulu, Oulu, Finland
2Department of Physiology, Research Unit of Biomedicine, Faculty of Medicine, University of Oulu, Oulu, Finland
Format: article
Version: accepted version
Access: embargoed
Persistent link:
Language: English
Published: Elsevier, 2021
Publish Date: 2022-07-01


Background and aims: Both carotid intima-media thickness (IMT) and arterial plaques have been shown to predict future CV events. Since there are no previous studies on the subject, our objective was to compare carotid IMT and the length of plaques in abdominal-pelvic main arteries in CV risk assessment in a prospective study setting with a follow-up of over 20 years.

Methods: A total of 1007 patients (50% men), aged 51 ± 6.0 years, participated in the current study. Carotid IMT and the summarized plaque length (SUM) from abdominal aorta to common femoral arteries were ultrasonographically assessed. Patients were followed-up a median (1st-3rd quartile) of 22.5 (17.5–23.2) years for CV events.

Results: SUM significantly predicted CV events (HR per every 10 mm increase: 1.035, 95% CI: 1.027–1.044, p < 0.001). Those in the highest SUM tertile had over 3-fold risk for CV event (HR: 3.392, 95% CI: 2.427–4.741, p < 0.001) when compared to those in the lowest tertile. SUM significantly predicted CV events even after adjusting for age, sex, hypertension, diabetes, smoking (pack-years), LDL cholesterol and IMT. Adding SUM to the established model improved C-index (95% CI) from 0.706 (0.674–0.738) to 0.718 (0.688–0.747) as well as both discrimination (p < 0.001) and reclassification (p < 0.001) of the patients. In contrast, IMT predicted cardiovascular events only in univariate analysis and it did not improve discrimination or reclassification of the patients.

Conclusions: In light of our findings, SUM is a superior indicator and clinical tool for evaluating the overall CV risk compared to carotid IMT.

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Series: Atherosclerosis
ISSN: 0021-9150
ISSN-E: 1879-1484
ISSN-L: 0021-9150
Volume: 330
Pages: 36 - 42
DOI: 10.1016/j.atherosclerosis.2021.06.925
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Copyright information: © 2021 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license