Review Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations?

Aims Measurement of change in carotid intima-media thickness (CIMT) has been proposed as an alterna-tive for the occurrence of cardiovascular (CV) events in the assessment of therapeutic interventions. Nevertheless, criticism has been voiced based on observations indicating a weak relation between CIMT and coronary atherosclerosis as well as on the virtual absence of data showing that progression of CIMT indeed predicts coronary artery disease (CAD) and stroke. Methods and resultsWe set out to review the evidence on these issues by performing a literature search on these topics. Of the 34 studies on the relation of CIMTwith coronary atherosclerosis, as assessed by angiography (n 33) or intravascular ultrasound (n 1), 30 showed a modest positive relationship; the magnitude of which was similar to that found in autopsy studies. Of all studies on CIMT and future CV events (n 18), 17 showed graded positive relationships. At present, only one study has provided evi-dence on the relation of change in CIMT and future CV events, showing an increased risk with CIMT pro-gression. The paucity of data on progression and future CV risk is partly attributable to time windows required to complete these studies. Conclusion The modest relation between CIMT and coronary atherosclerosis most likely reflects varia