Relative importance of various risk factors for asymptomatic carotid atherosclerosis versus coronary heart disease incidence - The atherosclerosis risk in communities study

Major risk factors for coronary heart disease are also associated with earl y carotid artery thickening, but no studies have yet examined patterns of r isk factors to see whether they differ for the two outcomes. Assuming simil ar pathogenesis for both coronary and carotid atherosclerosis, one could in terpret risk factor pattern differences as relating to differences in stagi ng, i.e., early atheroma versus later stenotic or occlusive atherothrombosi s. This study included 12,193 Atherosclerosis Risk in Communities Study par ticipants aged 45-64 years who were free of clinical cardiovascular disease in 1987-1989, in whom 420 myocardial infarctions or coronary heart disease deaths occurred over the next 6 years. Plasma low density lipoprotein chol esterol, systolic blood pressure, and smoking were major risk factors for b oth outcomes. Compared with these factors, triglycerides and high density l ipoprotein (HDL) cholesterol were associated only weakly with carotid ather osclerosis but were associated strongly with coronary heart disease inciden ce. No other risk factors, including those associated with diabetes mellitu s, hemostasis, and inflammation, differed in their relative contribution to the two outcomes. These results suggest that the high triglyceride-low HDL cholesterol pattern is involved in the transition from atheroma to atherot hrombosis, and that control of this pattern may be important in persons wit h detectable subclinical disease.