Percentiles of Carotid Intima-media Thickness in a Spanish Population With and Without Cardiovascular Risk Factors

doi:10.1016/j.rec.2013.04.012

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Vol. 66. Num. 9.

Pages 749-751 (September 2013)

Scientific letter
Percentiles of Carotid Intima-media Thickness in a Spanish Population With and Without Cardiovascular Risk Factors

Percentiles de grosor íntima-media carotídeo en población española con y sin factores de riesgo cardiovascular

María Graua ¿Isaac Subiranaa bJaume MarrugataRoberto Elosuaa

https://doi.org/10.1016/j.rec.2013.04.012

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2025 March	50	11	61
2025 February	34	12	46
2025 January	52	13	65
2024 December	53	14	67
2024 November	51	25	76
2024 October	59	17	76
2024 September	61	12	73
2024 August	53	31	84
2024 July	25	7	32
2024 June	19	9	28
2024 May	25	8	33
2024 April	35	30	65
2024 March	37	13	50
2024 February	35	17	52
2024 January	28	18	46
2023 December	24	7	31
2023 November	26	15	41
2023 October	23	22	45
2023 September	24	6	30
2023 August	27	11	38
2023 July	32	14	46
2023 June	42	14	56
2023 May	18	11	29
2023 April	16	9	25
2023 March	21	12	33
2023 February	27	20	47
2023 January	16	11	27
2022 December	27	9	36
2022 November	34	11	45
2022 October	22	16	38
2022 September	23	14	37
2022 August	33	17	50
2022 July	14	20	34
2022 June	40	13	53
2022 May	23	28	51
2022 April	41	16	57
2022 March	32	37	69
2022 February	18	26	44
2022 January	12	14	26
2021 December	19	26	45
2021 November	29	23	52
2021 October	28	18	46
2021 September	28	24	52
2021 August	22	18	40
2021 July	19	14	33
2021 June	18	12	30
2021 May	27	8	35
2021 April	46	33	79
2021 March	87	9	96
2021 February	66	5	71
2021 January	33	4	37
2020 December	36	5	41
2020 November	24	5	29
2020 October	34	8	42
2020 September	10	5	15
2020 August	29	9	38
2020 July	54	14	68
2020 June	18	9	27
2020 May	18	6	24
2020 April	30	8	38
2020 March	49	7	56
2020 February	58	6	64
2020 January	90	13	103
2019 December	53	11	64
2019 November	27	15	42
2019 October	28	6	34
2019 September	58	17	75
2019 August	64	30	94
2019 July	104	56	160
2019 June	88	67	155
2019 May	81	50	131
2019 April	62	21	83
2019 March	71	15	86
2019 February	82	18	100
2019 January	91	15	106
2018 December	117	15	132
2018 November	106	25	131
2018 October	96	25	121
2018 September	36	11	47
2018 August	42	17	59
2018 July	77	16	93
2018 June	71	10	81
2018 May	71	15	86
2018 April	38	4	42
2018 March	49	10	59
2018 February	45	11	56
2018 January	42	7	49
2017 December	40	12	52
2017 November	25	4	29
2017 October	34	6	40
2017 September	30	7	37
2017 August	25	14	39
2017 July	28	12	40
2017 June	52	8	60
2017 May	46	14	60
2017 April	34	8	42
2017 March	32	32	64
2017 February	68	5	73
2017 January	51	10	61
2016 December	33	12	45
2016 November	52	8	60
2016 October	75	17	92
2016 September	126	13	139
2016 August	63	5	68
2016 July	75	9	84
2016 June	74	21	95
2016 May	51	21	72
2016 April	64	11	75
2016 March	51	7	58
2016 February	61	27	88
2016 January	75	17	92
2015 December	60	19	79
2015 November	57	14	71
2015 October	58	19	77
2015 September	65	27	92
2015 August	76	20	96
2015 July	49	13	62
2015 June	47	11	58
2015 May	74	11	85
2015 April	78	7	85
2015 March	80	9	89
2015 February	58	13	71
2015 January	44	9	53
2014 December	26	8	34
2014 November	33	5	38
2014 October	33	10	43
2014 September	40	5	45
2014 August	34	9	43
2014 July	27	17	44
2014 June	48	7	55
2014 May	39	5	44
2014 April	37	7	44
2014 March	60	21	81
2014 February	52	5	57
2014 January	48	9	57
2013 December	59	21	80
2013 November	50	16	66
2013 October	54	14	68
2013 September	94	35	129
2013 August	68	54	122

To the Editor,

The measurement of carotid intima-media thickness (CIMT) has been used in cardiovascular epidemiology research over the past two decades in observational and interventional studies. A direct association has been found between carotid artery intima-media thickening and cardiovascular events. Although it seems unlikely that this measure provides a better estimation of cardiovascular risk in the total population, it does provide additional information on patients at intermediate cardiovascular risk.1

In Spain, there has been recent and increasing use of CIMT by different clinical and cardiovascular research groups.2–5 This motivated our decision to describe the population reference ranges of CIMT in 1708 women and 1453 men aged 35 to 84 years. The article, published in December 2012 in the Revista Española de Cardiología, included a graphical representation of the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of mean CIMT in the common carotid artery and all carotid artery segments, stratified by age and sex.6 We also calculated the 50th percentile of the mean values of both measures of CIMT in a subsample of 468 women and 306 men not exposed to cardiovascular risk factors (without hypertension, diabetes mellitus, and hypercholesterolemia, non-smokers, with high-density lipoprotein cholesterol levels >40mg/dL, and BMI <30kg/m2) stratified by age and sex.

In order to provide as much information as possible to facilitate the use of these data in clinical practice and clinical and epidemiological research, we present the percentiles of the general population on which these graphs were based. We also present the percentiles of the subsample without cardiovascular risk factors.

Carotid ultrasound examinations were performed with an Acuson XP 128 ultrasound machine equipped with an L75-10 MHz transducer and extended-frequency software (Acuson-Siemens; Mountainview, California, United States). Image files were recorded and sent to the Academic Vascular Image Centre in Amsterdam for analysis.

The 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles were estimated by age and sex, then adjusted using locally weighted scatterplot smoothing for the mean CIMT value of the common carotid artery (Table 1) and all carotid artery segments (common carotid artery, internal carotid artery, and carotid bulb) (Table 2) for the general population and the subsample without cardiovascular risk factors. Statistical analysis was performed using the R Statistical Package version 2.15.0 (R Foundation for Statistical Computing, Vienna, Austria).

Table 1.

Percentiles (5th, 10th, 25th, 50th, 75th, 90th, 95th) of Mean Common Carotid Artery Intima-media Thickness in the General Population and in Individuals Not Exposed to Cardiovascular Risk Factors, Stratified by Age and Sex

	General population (n=1708)										Population without cardiovascular risk factors* (n=468)
	35	40	45	50	55	60	65	70	75	80	35	40	45	50	55	60	65	70	75	80
Women
5%	0.439	0.460	0.482	0.505	0.525	0.541	0.557	0.573	0.597	0.629	0.441	0.464	0.486	0.509	0.533	0.561	0.597	0.639	0.690	0.750
10%	0.446	0.473	0.499	0.526	0.550	0.571	0.593	0.614	0.637	0.665	0.450	0.479	0.504	0.526	0.548	0.575	0.609	0.647	0.698	0.761
25%	0.471	0.502	0.532	0.560	0.586	0.611	0.638	0.669	0.699	0.727	0.475	0.505	0.532	0.559	0.586	0.615	0.646	0.675	0.727	0.799
50%	0.502	0.543	0.581	0.617	0.650	0.681	0.717	0.751	0.785	0.818	0.500	0.534	0.569	0.606	0.641	0.670	0.698	0.720	0.783	0.884
75%	0.541	0.589	0.634	0.677	0.717	0.756	0.803	0.845	0.893	0.947	0.517	0.564	0.614	0.668	0.720	0.755	0.772	0.774	0.837	0.959
90%	0.569	0.629	0.685	0.738	0.790	0.844	0.905	0.947	0.993	1.045	0.537	0.598	0.658	0.715	0.772	0.813	0.830	0.818	0.865	0.967
95%	0.584	0.651	0.713	0.772	0.830	0.892	0.965	1.022	1.068	1.106	0.543	0.614	0.681	0.743	0.802	0.844	0.858	0.839	0.877	0.970

	General population (n=1453)										Population without cardiovascular risk factors* (n=306)
	35	40	45	50	55	60	65	70	75	80	35	40	45	50	55	60	65	70	75	80
Men
5%	0.474	0.484	0.497	0.513	0.529	0.545	0.570	0.601	0.636	0.675	0.477	0.486	0.501	0.522	0.550	0.585	0.617	0.645	0.704	0.788
10%	0.501	0.508	0.519	0.534	0.552	0.574	0.608	0.638	0.667	0.696	0.483	0.501	0.519	0.539	0.563	0.595	0.629	0.656	0.715	0.796
25%	0.538	0.547	0.561	0.581	0.606	0.635	0.666	0.699	0.737	0.777	0.514	0.535	0.555	0.574	0.596	0.627	0.657	0.685	0.741	0.819
50%	0.590	0.609	0.630	0.654	0.681	0.712	0.750	0.787	0.828	0.874	0.563	0.581	0.600	0.623	0.652	0.686	0.706	0.731	0.781	0.852
75%	0.629	0.658	0.690	0.725	0.764	0.806	0.852	0.891	0.938	0.992	0.596	0.637	0.669	0.695	0.717	0.738	0.756	0.778	0.820	0.879
90%	0.652	0.722	0.778	0.821	0.852	0.885	0.937	0.976	1.038	1.125	0.607	0.681	0.733	0.764	0.779	0.788	0.804	0.820	0.853	0.898
95%	0.667	0.752	0.823	0.878	0.917	0.950	0.996	1.042	1.115	1.219	0.615	0.700	0.757	0.788	0.800	0.807	0.825	0.838	0.866	0.904

Individuals without hypertension, diabetes mellitus, and hypercholesterolemia, non-smokers, high-density lipoprotein cholesterol levels >40 mg/dL, and BMI <30kg/m2.

Table 2.

Percentiles (5th, 10th, 25th, 50th, 75th, 90th, 95th) of Mean All-carotid Intima-media Thickness in the General Population and in Individuals Not Exposed to Cardiovascular Risk Factors Stratified by Age and Sex

	General population (n=1708)										Population without cardiovascular risk factors* (n=468)
	35	40	45	50	55	60	65	70	75	80	35	40	45	50	55	60	65	70	75	80
Women
5%	0.449	0.474	0.497	0.520	0.539	0.557	0.576	0.592	0.607	0.621	0.469	0.483	0.500	0.522	0.547	0.577	0.609	0.634	0.676	0.731
10%	0.455	0.484	0.511	0.535	0.557	0.578	0.600	0.619	0.634	0.643	0.472	0.494	0.515	0.537	0.560	0.588	0.618	0.643	0.684	0.740
25%	0.477	0.512	0.544	0.572	0.596	0.619	0.645	0.671	0.690	0.704	0.482	0.514	0.541	0.564	0.588	0.617	0.648	0.670	0.711	0.771
50%	0.501	0.544	0.583	0.618	0.648	0.676	0.706	0.735	0.765	0.797	0.501	0.538	0.574	0.609	0.644	0.675	0.697	0.709	0.762	0.856
75%	0.532	0.583	0.632	0.678	0.720	0.757	0.784	0.811	0.855	0.915	0.543	0.574	0.613	0.660	0.717	0.762	0.775	0.760	0.819	0.950
90%	0.562	0.624	0.683	0.739	0.792	0.841	0.877	0.916	0.972	1.046	0.551	0.598	0.652	0.712	0.784	0.836	0.842	0.805	0.849	0.969
95%	0.569	0.641	0.712	0.779	0.844	0.901	0.940	0.987	1.041	1.099	0.556	0.615	0.680	0.750	0.831	0.883	0.874	0.820	0.856	0.974

	General population (n=1453)										Population without cardiovascular risk factors* (n=306)
	35	40	45	50	55	60	65	70	75	80	35	40	45	50	55	60	65	70	75	80
Men
5%	0.473	0.498	0.521	0.542	0.560	0.576	0.600	0.621	0.652	0.694	0.465	0.500	0.533	0.563	0.591	0.613	0.624	0.641	0.714	0.835
10%	0.491	0.514	0.536	0.560	0.582	0.603	0.629	0.651	0.681	0.719	0.476	0.512	0.545	0.575	0.603	0.626	0.636	0.651	0.721	0.839
25%	0.540	0.560	0.581	0.605	0.630	0.654	0.687	0.719	0.754	0.791	0.516	0.543	0.570	0.597	0.625	0.653	0.665	0.680	0.744	0.851
50%	0.586	0.607	0.632	0.659	0.691	0.725	0.760	0.796	0.828	0.853	0.579	0.602	0.625	0.649	0.675	0.701	0.708	0.723	0.783	0.881
75%	0.625	0.663	0.698	0.733	0.768	0.805	0.837	0.872	0.903	0.928	0.627	0.652	0.677	0.704	0.732	0.757	0.760	0.773	0.828	0.919
90%	0.663	0.724	0.775	0.817	0.852	0.887	0.932	0.978	1.024	1.070	0.641	0.689	0.727	0.757	0.780	0.796	0.793	0.805	0.857	0.943
95%	0.689	0.752	0.808	0.855	0.898	0.940	0.981	1.031	1.085	1.143	0.643	0.708	0.755	0.786	0.806	0.815	0.806	0.817	0.867	0.952

Individuals without hypertension, diabetes mellitus, and hypercholesterolemia, non-smokers, high-density lipoprotein cholesterol levels >40 mg/dL, and BMI <30kg/m2.

In general, CIMT values found in the common segment and common carotid artery in individuals not exposed to cardiovascular risk factors were lower than in the general population. These differences were more accentuated the higher the percentile. Moreover, in some cases the CIMT values of the participants older than 80 years with no risk factors were higher than those in the general population. It is possible that the small number of older participants without risk factors decreased the reliability of the estimations. Furthermore, these findings could be subject to survival bias; despite the advanced age of this population and the fact that they had greater CIMT than the age-matched general population, they had not experienced coronary events.

The results of this analysis provide the reference ranges of CIMT in the general population and in the subsample without cardiovascular risk factors. Further cohort studies are needed to ascertain the additional predictive value of CIMT for the incidence of cardiovascular events.

FUNDING

This research was supported by funding from the Government of Spain through the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III; European Regional Development Fund (Red de Investigación Cardiovascular RD12/0042/0013, RD12/0042/0061); Fondo de Investigación Sanitaria (FIS PI081327, FIS PI060258); CIBERESP and Miguel Servet (CP12/03287); Fundació La Marató de TV3 (081632); Agència de Gestió Ajuts Universitaris de Recerca (2009 SGR 1195); and Beca de la Fundación Española del Corazón, Fuente Liviana, and Spanish Society of Cardiology 2011.

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