Combining carotid intima-media thickness with carotid plaque on screening for coronary heart disease

J Med Screen 2009;16:155-159
doi:10.1258/jms.2009.009039
© 2009 Medical Screening Society

 

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Original Articles


David S WaldMD MRCP, Consultant Cardiologist and Senior Lecturer 
,


Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK


Jonathan P BestwickMSc, Statistician
,


Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK


Geraint MortonMRCP, Specialist Registrar
,


Southampton University Hospital, Tremona Road, Southampton SO16 6YD, UK


Linda DrummondMSc, Vascular Technician
,


Southampton University Hospital, Tremona Road, Southampton SO16 6YD, UK


Nick JenkinsMRCP, Specialist Registrar
,


Southampton University Hospital, Tremona Road, Southampton SO16 6YD, UK


Pouran Khodabakhsh, Vascular Technician
,


Vascular Studies Unit, Leicester Royal Infirmary, Leicester LE1 5WW, UK


Nick P CurzenPhD FRCP, Consultant Cardiologist and Senior Lecturer
,


Southampton University Hospital, Tremona Road, Southampton SO16 6YD, UK

Correspondence to: David S Wald, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; d.s.wald{at}qmul.ac.uk


Background Ultrasound-detected carotid artery intima-media thickness (IMT)and carotid plaque are possible screening tests for coronaryheart disease (CHD) among asymptomatic individuals.

Objective To assess the increase in screening performance of combiningcarotid IMT and plaque compared with each measurement alonein the identification of individuals with CHD.

Methods Ultrasound examination of left and right carotid arteries wasperformed on 100 individuals (median age 57), 55 with a historyof CHD (unstable angina or myocardial infarction) and 45 without.IMT measurements were taken from the common carotid artery andplaque was identified above, at and below the carotid bifurcation.Associations between IMT and plaque were determined using logisticregression, and screening performance was assessed from thedistributions of IMT and plaque among cases and controls.

Results At a false-positive rate of 5%, IMT (cut-off >0.75 mm) identified30% (95% CI 14–58) of affected individuals. There wasan increase in the detection rate of 8 percentage points (1–33%)using IMT and plaque combined compared with IMT alone. As thefalse-positive increased, the difference in the detection rateincreased, up to a maximum of 20 percentage points (5–38%)at a false-positive rate of 20%. The comparison of IMT and plaquecombined with plaque alone could only be estimated for the false-positiverate observed using plaque alone (18%); at this point the detectionrate was 72% for plaque and 75% for plaque and IMT combined,an increase of 3 percentage points (0–4%).

Conclusion In screening for CHD, combining carotid IMT measurement withplaque assessment is better than using either measurement alone,but the improvement in discrimination is not sufficient to makecarotid ultrasound screening for CHD worthwhile.


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This article has been cited by other articles:

Home page J Med ScreenHome page

D. S Wald and J. P Bestwick
Carotid ultrasound screening for coronary heart disease: results based on a meta-analysis of 18 studies and 44,861 subjects
J Med Screen,

September 1, 2009;
16(3):
147 – 154.

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