Circulation, Vol 82, 1230-1242, Copyright © 1990 by American Heart Association
TE Craven, JE Ryu, MA Espeland, FR Kahl, WM McKinney, JF Toole, MR McMahan, CJ Thompson, G Heiss and JR Crouse 3d
To evaluate the consistency, strength, and independence of the relation of
carotid atherosclerosis to coronary atherosclerosis, we quantified coronary
artery disease risk factors and extent of carotid atherosclerosis (B-mode
score) in 343 coronary artery disease patients and 167 disease-free control
patients. In univariable analyses, there was a strong association between
coronary status and extent of carotid artery disease in men and women older
than and younger than 50 years (p less than 0.001 for men and women greater
than 50 years, p less than 0.001 for women less than or equal to 50 years,
p = 0.045 for men less than or equal to 50). The relation remained strong
after control for age in men and women older than 50 years and in women
younger than 50 (p less than 0.001 for men and women greater than 50 years,
p = 0.003 for women less than or equal to 50) but did not persist after
control for age in men younger than 50. Logistic models that included
coronary disease risk factors, with or without B-mode score, as independent
variables and presence or absence of coronary disease as the outcome
variable indicated that the extent of carotid atherosclerosis was a strong,
statistically significant independent variable in models for men and women
older than 50 years of age. Next, we examined the usefulness of B-mode
score as an aid in screening for coronary artery disease in men and women
older than 50 years. Classification rules, both including and excluding
B-mode score, were developed based on logistic regression and, for
comparison, recursive partitioning (decision trees). The performance of
these rules and the bias of their performance statistics were estimated.
The improved classification of the study sample when B-mode score was
incorporated in the rule was statistically significant only for men (p =
0.015). However, the addition of B-mode score was found to 1) increase the
median discrimination score for both sex groups based on the logistic
model, and 2) yield better sensitivities and specificities for rules based
on recursive partitioning. Thus B-mode score is strongly, consistently, and
independently associated with coronary artery disease in patients older
than 50 and is at least as useful as well-known risk factors for
identifying patients with coronary artery disease.
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Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study
Department of Medicine, Wake Forest University Medical Center, Bowman Gray School of Medicine, Winston-Salem, NC 27103.
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