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Measurement of carotid intima–media thickness to assess progression and regression of atherosclerosis

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 280–288 (2008)Cite this article

Abstract

Imaging modalities have been developed to assess atherosclerosis in vivo in the arterial wall because large clinical end-point studies are time-consuming and costly. Historically, in-hospital angiography and Doppler ultrasonography have been used to assess atherosclerosis development. Investigations of the arterial lumen are, however, increasingly being replaced by modalities that can measure changes in the arterial wall itself—intravascular ultrasonography, MRI and multislice CT. The fact that intravascular ultrasonography is invasive, CT involves substantial radiation exposure and requires contrast agents, and that MRI is time-consuming and technically challenging all limit the widespread use of these techniques. Moreover, all modalities have high associated costs. B-mode ultrasonographic imaging of the carotid arterial walls occupies a unique position in atherosclerosis research. This method enables sensitive, reproducible and noninvasive assessment of intima–media thickness (IMT) as a continuous variable. Epidemiological and clinical trial evidence as well as digitization and standardization have made carotid IMT a validated and accepted marker for generalized atherosclerosis burden and vascular disease risk. Here we describe the application of carotid IMT measurements as a tool in risk evaluation of individuals and in studies of atherosclerosis progression and regression.

Key Points

  • In atherosclerosis research, surrogate markers are important in the early identification of disease, in risk assessment and the evaluation of drug efficacy

  • If imaging modalities are to be used in clinical studies and pharmaceutical trials, technical optimization and stringent standardization are required

  • Carotid ultrasonography is a noninvasive method for measuring carotid intima–media thickness–a validated surrogate marker of atherosclerotic disease—that allows atherosclerosis assessment in individuals across the entire cardiovascular risk spectrum

  • Carotid intima—media thickness measurements can be used to assess the consequences of cardiovascular disease risk reduction in patients and to investigate novel antiatherosclerotic strategies in clinical trials

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Figure 1: Brightness-mode ultrasound images of carotid artery wall segments from a 35-year-old asymptomatic male with a 14-year history of type 1 diabetes mellitus.
Figure 2: A composite ultrasonographic image of the carotid artery.
Figure 3: The arterial wall of the common carotid artery of an asymptomatic individual throughout life and the various stages of arterial wall thickening.
Figure 4: Schematic representation of sources of variability in intima–media measurement.
Figure 5: Intima–media thickness data from 95 unaffected siblings and 214 children with familial hypercholesterolemia aged 13.0 years (SD 3.0; range 7.9–18.9).

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Authors and Affiliations

  1. and JJP Kastelein is Professor of Medicine and Chairman of the Department of Vascular Medicine, E de Groot is Managing Director and ML Bots is Scientific Director of the Vascular Imaging Center, SI van Leuven, R Duivenvoorden, MC Meuwese and F Akdim are Research Physicians, Academic Medical Centre, Amsterdam, The Netherlands.,

    Eric de Groot, Sander I van Leuven, Raphaël Duivenvoorden, Marijn C Meuwese, Fatima Akdim, Michiel L Bots & John JP Kastelein

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  1. Eric de Groot
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Correspondence to Eric de Groot.

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de Groot, E., van Leuven, S., Duivenvoorden, R. et al. Measurement of carotid intima–media thickness to assess progression and regression of atherosclerosis. Nat Rev Cardiol 5, 280–288 (2008). https://doi.org/10.1038/ncpcardio1163

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