BACKGROUND: Several noninvasive methods are available to investigate the
severity of extracoronary atherosclerotic disease. No population-based
study has yet examined whether differences exist between these measures
with regard to their predictive value for myocardial infarction (MI) or
whether a given measure of atherosclerosis has predictive value
independently of the other measures. METHODS AND RESULTS: At the baseline
(1990-1993) examination of the Rotterdam Study, a population-based cohort
study among subjects age > or =55 years, carotid plaques and intima-media
thickness (IMT) were measured by ultrasound, abdominal aortic
atherosclerosis by x-ray, and lower-extremity atherosclerosis by
computation of the ankle-arm index. In the present study, 6389 subjects
were included; 258 cases of incident MI occurred before January 1, 2000.
All 4 measures of atherosclerosis were good predictors of MI independently
of traditional cardiovascular risk factors. Hazard ratios were equally
high for carotid plaques (1.83 [1.27 to 2.62], severe versus no
atherosclerosis), carotid IMT (1.95 [1.19 to 3.19]), and aortic
atherosclerosis (1.94 [1.30 to 2.90]) and slightly lower for
lower-extremity atherosclerosis (1.59 [1.05 to 2.39]), although
differences were small. The hazard ratio for MI for subjects with severe
atherosclerosis according to a composite atherosclerosis score was 2.77
(1.70 to 4.52) compared with subjects with no atherosclerosis. The
predictive value of MI for a given measure of atherosclerosis was
independent of the other atherosclerosis measures. CONCLUSIONS:
Noninvasive measures of extracoronary atherosclerosis are strong
predictors of MI. The relatively crude measures directly assessing plaques
in the carotid artery and abdominal aorta predict MI equally well as the
more precisely measured carotid IMT