Wall thickness of the carotid artey as an indicator of generalized atherosclerosis : the Rotterdam study

Abstract

The past decades have led to a better understanding of the etiology and pathogenesis of atherosclerosis and its clinical sequelae. Several risk factors have been identified that promote atherosclerosis to develop and of which it is currently known that their presence increases the risk of cardiovascular disease. At present, cardiovascular disease is believed to be caused by an interplay of advanced atherosclerotic vessel wall changes, stenosis and thrombosis. However, the question why some people suffer from a cardiovascolar event whereas others may be SPared from SYffiptomatic cardiovascular disease remains unanswered. This is in particular important for subjects of older age, since in these subjects some extent of atherosclerosis is already present. Non-invasive techniques to accurately assess atherosclerotic vessel wall abnormalities may be used to smdy the atherosclerotic process in population-based studies in order to gain further insight in factors that initiate the atherosclerotic process, lead to progression of atherosclerosis, and cause disease to manifest itself in the absence or presence of atherosclerotic vessel wall abnormalities. High resolution B-mode ultrasonography of carotid arteries may provide a tool to study signs of early and advanced atherosclerosis, to monitor the process of development of atherosclerosis and to study factors which promote development and progression of atherosclerotic vessel wall disease and subsequent clinical cardiovascular disease in populations at large.'-" The main objectives of the studies presented in this thesis were to evaluate the feasibility of non-invasive assessment of hemodynamically important stenosis of the carotid artery and common carotid intima-media thickness, in an elderly non-hospitalized population; to study the value of increased intima-media thickness of the distal common carotid artery as an indicator of generalized atherosclerosis; to study determinants of increased common carotid intima-media thickness. In chapter 3, a general outline is given of the principles of the ultrasound technique and a detailed description of the ultrasound reading protocol as it is used in the Rotterdam Study is provided. Furthermore, the reproducibility of the ultrasonographic measurements of common carotid intima-media thickness is presented in this chapter. The associations between intima-media thickness of the distal common carotid artery and indicators of atherosclerosis in other arteries are descnoed in chapter 4. Results from studies on the association between common carotid intima-media thickness and cardiovascular risk factors are discussed in chapter 5, whereas chapter 6 deals with the prevalence and determinants of carotid atherosclerosis diagnosed as hemodynamically important stenosis. The findings presented in chapter 7 concern the association between cerebral white matter lesions and non-invasively assessed atherosclerosi