Intima-media thickness at the near or far wall of the common carotid artery in cardiovascular risk assessment

Lisa Seekircher, Lena Tschiderer, Lars Lind, Maya S. Safarova, Maryam Kavousi, M. Arfan Ikram, Eva Lonn, Salim Yusuf, Diederick E. Grobbee, John J. P. Kastelein, Frank L. J. Visseren, Matthew Walters, Jesse Dawson, Peter Higgins, Stefan Agewall, Alberico Catapano, Eric de Groot, Mark A. Espeland, Gerhard Klingenschmid, Dianna MaglianoMichael H. Olsen, David Preiss, Dirk Sander, Michael Skilton, Dorota A. Zozulińska-Ziółkiewicz, Muriel P. C. Grooteman, Peter J. Blankestijn, Kazuo Kitagawa, Shuhei Okazaki, Maria V. Manzi, Costantino Mancusi, Raffaele Izzo, Moise Desvarieux, Tatjana Rundek, Hertzel C. Gerstein, Michiel L. Bots, Michael J. Sweeting, Matthias W. Lorenz, Peter Willeit

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


Aims: Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive values. Methods and results: We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02 mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [r = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; I² = 30.7%) and 1.20 (1.18-1.23; I² = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; I² = 8.4%) and 1.14 (1.12-1.16; I²=1.3%) upon multivariable adjustment (all P < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near (P < 0.001), +0.0037 for far wall (P = 0.006)]. Conclusions: The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls.

Original languageEnglish
Article numberoead089
JournalEuropean heart journal open
Issue number5
Publication statusPublished - 1 Sept 2023


  • Cardiovascular risk
  • Common carotid artery intima-media thickness
  • Individual-participant-data meta-analysis

Cite this