Back to Journals » Vascular Health and Risk Management » Volume 10

The triple line pattern on carotid intima media thickness imaging and its relationship to cardiovascular risk factors in patients on lipid lowering therapy

Authors Singh T, Villines T, Taylor A

Received 2 May 2013

Accepted for publication 15 July 2013

Published 20 June 2014 Volume 2014:10 Pages 363—366


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Tania A Singh,1 Todd C Villines,2 Allen J Taylor3

1Division of Cardiology, Medstar Georgetown University Hospital, 2Walter Reed National Military Medical Center, Bethesda, MD, 3Georgetown University School of Medicine, Washington, DC, USA

Background: Carotid intima media thickness (CIMT) infrequently identifies a triple line pattern (TLP) in the visualization of the internal elastic lamina. We examined the prevalence and predictors of the TLP among a consecutive series of subjects enrolled in a CIMT clinical trial, and also the effects of lipid lowering therapy.
Methods: Baseline CIMT studies of subjects with known heart disease, or high risk for heart disease, were evaluated from a single site of the Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6-HDL and LDL Treatment Strategies in Atherosclerosis trial (N=120). One sonographer obtained four views of the right and left far wall common CIMT, using a 13 MHz ultrasound probe. Images were blindly reviewed for the presence of the TLP. The TLP was defined as absent (0), possible (1), or definite (2). A composite score from all four views was calculated. A patient was defined as having the TLP if the composite score was ≥4. Univariate predictors of the TLP were explored. Follow-up ultrasounds at 14 months were also reviewed for presence of the TLP.
Results: The prevalence of the TLP at baseline was 22.5%. Among cardiovascular risk variables, systolic blood pressure was significantly higher in subjects displaying the TLP (141.3±15.6 mmHg versus 133.1±18.4 mmHg; P=0.036). There were no differences among those with, and without, the TLP, with respect to other cardiovascular risk variables (age, sex, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, C-reactive protein, glucose, weight, waist girth, tobacco use, medications, quantitative CIMT), or image quality. During ongoing lipid lowering therapy, the prevalence of the TLP increased to 54.2% (P<0.001). However, it was unrelated to changes in lipid concentrations or cardiovascular risk variables.
Conclusion: The TLP in CIMT imaging is commonly identifiable using high-frequency ultrasound, and appears to be associated with higher systolic blood pressure. Its prevalence and incidence is unrelated to lipid parameters.

Keywords: risk factors, HTN, atherosclerosis, CIMT

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]


Readers of this article also read:

Platelet function tests: a comparative review

Paniccia R, Priora R, Alessandrello Liotta A, Abbate R

Vascular Health and Risk Management 2015, 11:133-148

Published Date: 18 February 2015

Optimal management of infrainguinal arterial occlusive disease

Pennywell DJ, Tan TW, Zhang WW

Vascular Health and Risk Management 2014, 10:599-608

Published Date: 24 October 2014

Consumption of water containing over 3.5 mg of dissolved hydrogen could improve vascular endothelial function

Sakai T, Sato B, Hara K, Hara Y, Naritomi Y, Koyanagi S, Hara H, Nagao T, Ishibashi T

Vascular Health and Risk Management 2014, 10:591-597

Published Date: 17 October 2014

Update on ranolazine in the management of angina

Codolosa JN, Acharjee S, Figueredo VM

Vascular Health and Risk Management 2014, 10:353-362

Published Date: 24 June 2014

Telemonitoring: use in the management of hypertension

Sivakumaran D, Earle KA

Vascular Health and Risk Management 2014, 10:217-224

Published Date: 10 April 2014

Cerebral blood flow in Alzheimer’s disease

Roher AE, Debbins JP, Malek-Ahmadi M, Chen K, Pipe JG, Maze S, Belden C, Maarouf CL, Thiyyagura P, Mo H, Hunter JM, Kokjohn TA, Walker DG, Kruchowsky JC, Belohlavek M, Sabbagh MN, Beach TG

Vascular Health and Risk Management 2012, 8:599-611

Published Date: 23 October 2012