Use of carotid intima-media thickness and vascular age to modify cardiovascular risk prediction.

BACKGROUND This study identified predictors of patients for whom carotid artery intima-media thickness (CIMT) measurement and determination of vascular age could change cardiovascular disease (CVD) risk assessment. METHODS We studied consecutive patients who were asymptomatic and nondiabetic, referred for ultrasound measurement of CIMT. Individuals with CIMT 75th percentile or greater for age, sex, and race were defined as having advanced subclinical atherosclerosis. CIMT values were converted to vascular age estimates and were used to modify Framingham 10-year CVD risk estimates. RESULTS Of 506 patients, 261 (51.6%) were not taking lipid-lowering therapy. Advanced subclinical atherosclerosis was present in 77 (30%). There were 62 patients (23.8%) with a change in CVD risk of 5% or more. Predictors of 5% or more change in CVD risk were systolic blood pressure (P < .001), total/high-density lipoprotein cholesterol ratio (P < .001), and male sex (P < .001). Of the 97 patients at moderate or moderately high risk, 56.7% changed risk classification. CONCLUSIONS Measurement of CIMT and determination of vascular age can identify individuals with advanced subclinical atherosclerosis, resulting in clinically meaningful alterations in CVD risk estimates.