Carotid intima media thickness as marker of atherosclerosis : results of the IMPROVE Study

The intima-media thickness (IMT) of extracranial carotid arteries, measured by high-resolution B-mode ultrasound has been proposed as an useful surrogate marker of atherosclerosis in carotid arteries and in other vascular regions. IMT is a good predictor of new myocardial infarction and it has been shown to be infl uenced by drugs known to reduce cardiovascular events, which supports the concept that IMT represents a biomarker of atherosclerosis. Carotid IMT alone has the same predictive capacity of VRFs. In a longitudinal - observational study, we have shown that the integrated use of VRFs included into the Framingham risk score and ultrasonic measurements of carotid IMT significantly increase their capacity to predict cardiovascular events in patients at low/intermediate risk. The integration of carotid IMT with non conventional VRFs may further optimize the stratification of patient risk. Another important carotid ultrasonic variable that may have predictive capacity, alone or when integrated with conventional or non conventional risk factors, is the progression of carotid IMT. A prospective, multicenter, longitudinal, long term, observational study (The IMPROVE study) is currently ongoing. It aims to investigate the capacity of both cross sectional carotid IMT and overall IMT-progression to predict alone, or after integration with both conventional and non conventional VRF, the rate of new vascular events in an European population classifi ed at high risk of cardiovascular disease for the presence of at least 3 VRFs. The patients’ enrolment ended in April 2005 and a total of 3711 patients were recruited in 6 European countries. Funding: Italian Ministry of Health, European Commission, IMPROVE project