Carotid intima-media thickness and coronary atherosclerosis: Weak or strong relations?

Michiel L. Bots, Damiano Baldassarre, Alain Simon, Eric De Groot, Daniel H. O'Leary, Ward Riley, John J. Kastelein, Diederick E. Grobbee

Research output: Contribution to journalArticlepeer-review


Aims: Measurement of change in carotid intima-media thickness (CIMT) has been proposed as an alternative for the occurrence of cardiovascular (CV) events in the assessment of therapeutic interventions. Nevertheless, criticism has been voiced based on observations indicating a weak relation between CIMT and coronary atherosclerosis as well as on the virtual absence of data showing that progression of CIMT indeed predicts coronary artery disease (CAD) and stroke. Methods and results: We set out to review the evidence on these issues by performing a literature search on these topics. Of the 34 studies on the relation of CIMT with coronary atherosclerosis, as assessed by angiography (n = 33) or intravascular ultrasound (n = 1), 30 showed a modest positive relationship; the magnitude of which was similar to that found in autopsy studies. Of all studies on CIMT and future CV events (n = 18), 17 showed graded positive relationships. At present, only one study has provided evidence on the relation of change in CIMT and future CV events, showing an increased risk with CIMT progression. The paucity of data on progression and future CV risk is partly attributable to time windows required to complete these studies. Conclusion: The modest relation between CIMT and coronary atherosclerosis most likely reflects variability in atherosclerosis development between the vascular beds rather than limitations of CIMT measurements. Additional data on the relation between change in CIMT and future CV events is required and currently is in progress.

Original languageEnglish
Pages (from-to)398-406
Number of pages9
JournalEuropean Heart Journal
Issue number4
Publication statusPublished - Feb 2007


  • Carotid atherosclerosis
  • Hypertension
  • Statin
  • Surrogate endpoints
  • Trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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