1 INTIMA MEDIA THICKNESS AND ATHEROSCLEROSIS Michele CAZAUBON, MD, PhD American Hospital of Paris ( France)

2 INTIMA MEDIA THICKNESS AND ATHEROSCLEROSIS ATHEROSCLEROSIS = ARTERIAL WALL DISEASE CLINICAL MANIFESTATIONS WHEN ADVANCED IMPORTANCE OF SCREENING FOR PRECLINICAL STAGE

3 DOPPLER ULTRASOUND IMAGING DOPPLER ULTRASOUND IMAGING AND ARTERIAL WALL AND ARTERIAL WALL PLAQUE GRADE % ECHOGENICITY I NTIMA -M EDIA THICKNESS (IMT)

4 ANATOMICAL AND HISTOLOGY STUDY NORMAL ARTERIAL WALL IN B.MODE ULTRASOUND  1 st ECHOGENIC LINEA =1 st ECHOGENIC LINEA = LUMEN/INTIMA INTERFACE LUMEN/INTIMA INTERFACE 2 nd ECHOGENIC LINEA = / MEDIAL / ADVENTITIAL PIGNOLI ( Circulation 1986)

5 IMT & A THEROSCLEROSIS E= IMT D = DIAMETER Nb = NB OF Points 212/1cm

6 NORMAL VALUES IMT 0, 36 mm TO 0, 90mm = NORMAL VALUE IMT FOR ADULTS AT THE SAME AGE : IMT > MEN / WOMEN  LINEARLY WITH AGE :0,08 mm/year (SALONEN AND SALONEN ATHEROSCLEROSIS 1990 )

7 FEASABILITY OF MEASURE 1/ CAROTID ARTERY DISTAL COMMON CAROTID = 99% > BIFURCATION AND INTERNAL CAROTID

8 IMT AND « CLASSICAL » RISK FACTORS AGE GENDER SMOKING HIGH BLOOD PRESSURE CHLOL  AND DIABETE

9 NEW RISK FACTORS /1 1 1/ HYPERHOMOCYSTEINEMIA ASAP ( Antioxidant Supplementation in Atherosclerosis Prevention study ) -EIM  dans groupe avec HC  (SALONEN ANN MED INT 1998)

10 NEW RISK FACTORS /2 2/ STANDING AT WORK  PROGRESSION = 0,08 to 0,67mm between men standing at work NEVER / ALWAYS. (SALONEN Environ Health 2000)

11 IMT & A THEROSCLEROSIS NEW RISK FACTORS 2/ STANDING AT WORK  « REDUCING THE DURATION OF STANDING AT WORK SHOULD BE CONSIDERED IN THE PRIMARY PREVENTION OF ATHEROSCLEROSIS » (SALONEN Environ Health 2000)

12 IMT = SENSITIVE INDICATOR FOR THE PRESENCE OF PLAQUE IN THE BIFURCATION OF COMMON CAROTID EVA ’ STUDY ( Broussais sujets 4 years follow up)

13 IMT c AND CAROTID STENOSIS CORRELATION BETWEEN IMT c AND SEVERITY ATHEROSCLERIS

14  ASSOCIATION BETWEEN IMT  AND  PREVALENCE OF PLAQUES  BASELINE IMT - CCA IS AN INDEPENDANT PREDICTOR OF CAROTID PLAQUE OCCURRENCE  INCREASED WALL THICKNESS PRECEDE PLAQUE FORMATION

15 IMT & CAROTID A THEROSCLEROSIS ROTTERDAM STUDY : RISK ATHEROSCLEROTIC PLAQUES IN THE BIF CAR X6 between IMT 0,63 mm / IMT 0,89 mm ( subjects population based study. GRADE B )

16 C IMT   MYOCARDIAL INF. STROKE 1/ INCLUSION = 4476 SUBJETCS > 65 YEARS WITHOUT CARDIO VASCULAR DISEASE INCLUSION IMT measured : CC and Cint. = 5 QUINTILES 2/ FOLLOW UP = 6,2 YEARS O ’LEARY et col. NEJM 1999 CARDIOVASCULAR HEALTH STUDY

17 RELATIVE RISK OF MYOCARDIAL INFARCTION AND STROKE / IMT ( first to fifth quintile) ___________________________________________________ IMT MI STROKE 1Q-5Qba ba CC4,502,463,862, CI4,8433,662, CC+CI6,303,614,572,57 __________________________________________________ __ b= inajusted a= after adjusted for age, sex and other risk factor. O ’LEARY et col. NEJM 1999 CARDIOVASCULAR HEALTH STUDY

18 CONCLUSIONS OF THE STUDY INTIMA MEDIA THICKNESS OF CC AND IC STRONGLY ASSOCIATED WITH THE RISK OF MYOCARDIAL INFARCTION AND STROKE IN ASYMPTOMATIC OLDER ( > 65 years ) ADULTS.

19 IMT AND CORONARY  CCA AND ICA IMT ARE ASSOCIATED WITH EXISTING CORONARY HEART DISEASE

20 IMT AND THERAPEUTIC INTERVENTIONS LIPID LOWERING TREATMENT : STATINES +++ PRIMARY PREVENTION( ACAPS /CAIUS/KAPS) SECONDARY PREVENTION ( PLAC II/MARS/REGRESS) = REGRESSION OF PROGRESSION OF IMT BLOOD PRESSURES LOWERING DRUGS = DISCORDANCE HORMONE REPLACEMENT THERAPY = DISCORDANCE

21 MENOPAUSE/ IMT / AND CAROTID PLAQUES HORMONAL. NUMBER IMT c PLAQUES TREATMENT ( median value) HRT ,729mm 15% HR T ,782mm 51% HRT + = with hormonal replacement therapy HRT - = without hormonal replacement therapy p< 0,005 for IMT c and < 0,0001 for plaques M. CAZAUBON FA ALLAERT ANGEIOLOGIE 2001

22 CONCLUSIONS ULTRASOUND IMT MEASUREMENT = METHOD NON INVASIVE REPRODUCTIBLE NON EXPENSIVE FOR DETECTION OF EARLY ATHEROSCLEROSIS

23 CONCLUSIONS STRONG ASSOCIATION WITH VARIOUS RISK FACTORS FOR ATHEROSCLEROSIS ( classical and emergent) STRONG PRONOSTIC VALUE FOR CARDIOVASCULAR EVENTS = STROKE AND MYOCARDIAL INFARCTION IMT = GOOD MARKER FOR EFFICACITY OF ANTIATHEROGENIC DRUGS STRONG SENSIBILITY FOR STRATIFIACTION OF PETIENTS AT HIGH RISK FOR CARDIOVASCULAR DISEASE