Carotid arterial diameter enlargement is a manifestation of arterial remodeling and may be a risk factor for cardiovascular disease (CVD). We evaluated the association between carotid artery diameter and risk of stroke, coronary heart disease, CVD, and all-cause mortality and explored whether the associations could be explained by processes involved in arterial remodeling, that is, blood pressure-related media thickening, arterial stiffness, arterial wall stress, and atherosclerosis. We included 4887 participants (mean age 67±9 years; 54% women) from 4 cohort studies: Rotterdam Study, NEPHROTEST, Hoorn Study, and a study by Blacher et al. Common carotid artery properties were measured using echotracking. Incident cases were recorded based on medical records. We used Cox proportional hazard models adjusting for cardiovascular risk factors and estimates of processes underlying arterial remodeling. During follow-up (mean, 11 years), 379 (8%) individuals had a stroke, 516 had a (11%) coronary heart disease, 807 had a (17%) CVD, and 1486 (30%) had died. After adjustment for cardiovascular risk factors, individuals in the highest tertile of carotid diameter (diameter >8 mm) compared with those in the lowest tertile (diameter <7 mm) had a higher incidence of stroke (hazard ratio, 1.5; 95% confidence interval, 1.1-2.0). From all estimates of processes underlying arterial remodeling, adjustment for carotid intima-media thickness attenuated this association (hazard ratio after adjustment for intima-media thickness, 1.2; 95% confidence interval, 0.9-1.6). Larger carotid diameter was associated with risk of CVD and mortality but not clearly with coronary heart disease risk. We showed that a larger carotid diameter is associated with incident stroke, CVD, and mortality. Carotid intima-media thickness, a measure of blood pressure-related media thickening, partially explained the association with stroke incidence.
Bibliographical noteFunding Information:
T. Van Sloten and C.D.A. Stehouwer are supported by the European Regional Development Fund as part of OP-ZUID, the province of Limburg, the Department of Economic Affairs of the Netherlands (grant 31O.041), Stichting the Weijerhorst, the Pearl String Initiative Diabetes, the Cardiovascular Centre Maastricht, Cardiovascular Research Institute Maastricht, School for Nutrition, Toxicology and Metabolism, Stichting Annadal, and Health Foundation Limburg. M. Kavousi is supported by the VENI grant (91616079) from The Netherlands Organization for Health Research and Development (ZonMw). O.H. Franco works in ErasmusAGE, a center for aging research across the life course funded by Nestlé Nutrition (Nestec, Ltd); Metagenics, Inc; and AXA. S. Laurent, G.M. London, B. Pannier, and P. Boutouyrie are supported by Assistance Publique Hopitaux de Paris, Paris Descartes University, and National Institute for Health and Medical Research (INSERM). The Hoorn Study was supported by grants from the Netherlands Organization for Health Research and Development, the Netherlands Heart Foundation, and the Dutch Diabetes Foundation. The NEPHROTEST study was supported by grants from Programme Hospitalier de Recherche Clinique, French Ministry of Health; and INSERM. The Rotterdam Study is supported by the Erasmus MC, and Erasmus University Rotterdam; the Netherlands Organisation for Scientific Research; the ZonMw; the Research Institute for Diseases in the Elderly; the Netherlands Genomics Initiative; the Ministry of Education, Culture and Science; the Ministry of Health Welfare and Sports; the European Commission (DG XII); and the Municipality of Rotterdam.
- carotid artery, common
- cohort studies