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30-03-2011 | Cardiometabolic | Article

Multiple risk factors should be considered for CV risk stratification


Free abstract

MedWire News: Cardiovascular (CV) risk assessment should focus on multiple risk factors rather than only one, say researchers who found that harmful increases in femoral and carotid intima media thickness (IMT) were associated with increases in the number of risk factors in asymptomatic young adults.

"These findings underscore the importance of multiple risk factor profiling in early life," the team explains in the journal Atherosclerosis.

Timir Paul, from the Tulane University Health Sciences Center in New Orleans, Louisiana, USA, and colleagues used data from the Bogalusa Heart Study to examine the effect of multiple CV risk factors on measures of femoral and carotid IMT (assessed by B-mode ultrasonography) in 1080 asymptomatic study participants aged 24-43 years.

Four peripheral arterial sites were evaluated: the common carotid, carotid bulb, internal carotid, and composite carotid, as well as femoral artery segments.

Risk factors included were adverse (>75th percentile for the study group) total cholesterol/high-density lipoprotein (HDL) cholesterol ratios, and increased waist circumference, systolic blood pressure, and insulin levels, as well as smoking.

Paul and team report that systolic blood pressure, age, male gender, total/HDL cholesterol ratio, and smoking were all independent predictors of femoral and carotid IMT, accounting for 11% of the variability in femoral IMT, 28% in common carotid, 18% in carotid bulb, 10% in internal carotid, and 27% in composite carotid segments.

For all arterial segments, systolic blood pressure and age were the major determinant risk factors for IMT, except carotid bulb, for which age was the major predictor.

The researchers found significant increases in the mean IMT of femoral and carotid segments with increasing number of CV risk factors, but to different degrees according to the site.

Specifically, respective mean IMT values for patients with 0, 1-2, 3, and 4-5 risk factors were 0.63, 0.68, 0.76, and 0.78 mm for femoral, 0.72, 0.74, 0.80, and 0.89 mm for common carotid, 0.90, 0.95, 1.03, and 1.12 mm for carotid bulb, 0.68, 0.71, 0.75, and 0.79 mm for internal carotid, and 0.77, 0.80, 0.87, and 0.93 mm for composite carotid, after adjusting for age, gender, smoking, and metabolic syndrome risk factors.

"Taken together, these findings emphasize the adverse impact of risk factors on the underlying subclinical atherosclerosis," write Paul et al.

They add that measures of IMT should therefore be considered, along with traditional risk factors, for CV risk stratification in the future.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Nikki Withers