Carotid-Artery Intima and Media Thickness as a Risk Factor for Myocardial Infarction and Stroke

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Abstract
Better predictors of stroke and myocardial infarction are clearly needed. The article by O'Leary and colleagues (Jan. 7 issue),1 which draws attention to the association between carotid-artery intima–media thickness and the risk of stroke and myocardial infarction in asymptomatic men and women who are 65 years of age or older, has made a contribution. However, the technology they used is complex and expensive, and the differences in carotid-artery intima–media thickness between patients at high risk and those at low risk are too small for common clinical use. The report by O'Leary et al. proposes the use of a sophisticated morphometric test of carotid structure as an additional screening test for vascular risk, to complement information about known risk factors. Is this test warranted in healthy older persons? Is it warranted when simpler functional tests (e.g., carotid tonometry, measurement of pulse pressure, or measurement of aortic pulse-wave velocity) may provide more information at a lower cost?