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L. Michael Prisant, MD; Paula C. Zemel, PhD; Fenwick T. Nichols, MD; Michael B. Zemel, PhD; James R. Sowers, MD; Albert A. Carr, MD; William O. Thompson, PhD; M. Gene Bond, PhD

Arch Intern Med. 1993;153(4):501-506.

Abstract
Objective
To assess the relationship between cardiovascular risk factors and carotid plaque.

Design
Hypertensive patients were screened for randomization into the Multicenter Isradipine Diuretic Atherosclerosis Study, a trial intended to determine if blood pressure control by isradipine as compared with hydrochlorothiazide will blunt the progression of carotid plaque (intima plus media thickness, 1.3 to 3.5 mm) in patients with serum cholesterol levels of less than 6.85 mmol/L (265 mg/dL) without insulin-dependent diabetes mellitus or estrogen therapy. Demographics of those who underwent B-mode ultrasound evaluations at common, bifurcation, and internal carotid artery sites to detect plaque were assessed from a southern and a northern site.

Setting
Participants were from ambulatory outpatient clinics associated with medical schools.

Patients
The initial screening included 1823 hypertensive volunteer patients who were between 40 and 83 years of age who had a diastolic pressure of 90 to 114 mm Hg (or <90 mm Hg with treatment).

Outcome Measures
Complete data were collected on the variables of age, cholesterol, cigarette smoking, race, gender, and the presence of carotid plaque in 1126 patients.

Results
All variables were significantly associated with carotid plaque (intima plus media thickness, 1.3 mm). The adjusted percentage with plaque was 66.4% ±3.4% for blacks and 70.1%±2.3% for whites at the southern site and 42.7%±4.5% for blacks and 61.3%±3.2% for whites at the northern site. The rate of plaque was 75.8% among cigarette smokers, despite a mildly elevated cholesterol level. Conclusions: Although these 1126 cases do not constitute a random sample of patients, these data suggest that there may be regional differences in racial tendencies toward plaque among blacks.

(Arch Intern Med. 1993;153:501-506)

Author Affiliations
From the Department of Medicine (Drs Prisant and Carr), Department of Neurology (Dr Nichols), and Office of Biostatistics (Dr Thompson), The Medical College of Georgia, Augusta; the Nutrition Department, University of Tennessee, Knoxville (Drs P. Zemel and M. Zemel); the Division of Endocrinology and Hypertension, Wayne State University, Detriot, Mich (Dr Sowers); and the Division of Vascular Ultrasound Research, Bowman Gray School of Medicine, Winston-Salem, NC (Dr Bond).

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