Although angiographic evidence of coronary atherosclerosis is one of the best predictors of clinical events, non-invasive imaging of this arterial bed is not yet possible. The availability of non-invasive methods for imaging the carotid arteries, and the intra-individual similarity of extent of disease in the coronary and carotid arteries provides rationale for this study that will assess the usefulness of B-mode ultrascan evaluation of extracranial carotid artery atherosclerosis as an independent predictor of clinical sequellae (fatal and non-fatal myocardial infarction (MI) and stroke). In the same patients this project aims to define predictors of progession of extracranial carotid atherosclerosis per se. This project takes advantage of pilot data already developed with B-mode ultrascan of the carotid arteries. These pilot studies define the reproducibility of the B-mode method and its usefulness as a research tool in patients undergoing coronary angiography; and, the proposed project will utilize this already developing patient population. The project also takes advantage of a collaboration between the University of North Carolina School of Public Health and the Wake Forest University Medical Center.
The specific aims are: to access a cohort of 600 individuals older than 50 with defined coronary anatomy and defined extent of extracranial carotid atherosclerosis; to measure traditional (lipids, lipoproteins, blood pressure, diabetic status, smoking history, etc.) and non-traditional (apolipoproteins, genetic markers) risk factors for coronary disease in this cohort; and, to follow this cohort for from 3 1/2 to 8 1/2 years for incidence of clinical events (follow-up will be by mailer, telephone contact and review of pertinent medical information). Multivariate techniques will be used to relate accession status (coronary atherosclerosis, carotid atherosclerosis, traditional and non-traditional risk factors) to (separately) 1) all cause mortality; 1) fatal and non-fatal MI; and 3) fatal and non-fatal stroke. The same volunteers will be re-evaluated by B-mode for extent of carotid atherosclerosis periodically (360 will be re-studied at their 5-year anniversary and a high-risk and low-risk subset will be evaluated at both 2 1/2 and 5 years), and multivariate analysis will be used to relate accession status to rate of disease progression. Data generated from this study will bear on the interrelationships between coronary and carotid atherosclerosis and their clinical sequellae and will help define predictors of atherosclerosis progression.
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