The triple line pattern on carotid intima media thickness imaging and its relationship to cardiovascular risk factors in patients on lipid lowering therapy
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
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php 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:
Paniccia R, Priora R, Alessandrello Liotta A, Abbate R
Published Date: 18 February 2015
Uptitrating amlodipine significantly reduces blood pressure in diabetic patients with hypertension: a retrospective, pooled analysis
Jeffers BW, Bhambri R, Robbins J
Published Date: 14 November 2014
Pennywell DJ, Tan TW, Zhang WW
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
Published Date: 17 October 2014
A clinician’s perspective: novel oral anticoagulants to reduce the risk of stroke in nonvalvular atrial fibrillation – full speed ahead or proceed with caution?
Published Date: 21 August 2014
Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality
Harris PR, Stein PK, Fung GL, Drew BJ
Published Date: 5 August 2014
Cardiac angiosarcoma: utility of [18F]fluorodeoxyglucose positron emission tomography–computed tomography in evaluation of residue, metastases, and treatment response
Tokmak H, Demir N, Demirkol MO
Published Date: 27 June 2014
Codolosa JN, Acharjee S, Figueredo VM
Published Date: 24 June 2014
Sivakumaran D, Earle KA
Published Date: 10 April 2014
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
Published Date: 23 October 2012