Addition of CRP or subclinical carotid atherosclerosis to conventional risk factors resulted in a modest increase in the ability to predict CVD. In the LBH589 nmr NOMAS population, presence of carotid

plaque considerably contributed to the better estimation of 10-year Framingham vascular risk [14]. More than a half of individuals in low and moderate FRS categories were reclassified into the higher risk category if carotid plaque was present. Traditional CVD risk prediction schemes need further improvement and cIMT and plaque may help improve CVD risk prediction with a direct implication for the risk stratification and treatment in vascular preventive programs. The localization of atherosclerosis is determined by hemodynamic forces, like shear stress and tensive forces, and additional local predisposing factors [27]. Since these local factors and hemodynamical

forces are distributed variably in the carotid vessels there are differences in the distribution and development of cIMT. A population-based study on the association of IMT at various sites and cardiovascular risk factors showed that IMT in the common carotid artery (CCA IMT) is correlated with risk factors for stroke and prevalent stroke. Conversely, intima–media thickness in the bifurcation, together with carotid plaque, were more directly associated with risk factors of ischemic heart disease and prevalent ischemic heart LGK 974 disease [28]. Systolic blood pressure seems to be the most important factor influencing IMT in the common carotid artery, whereas smoking may be more important for IMT in the internal carotid artery (ICA IMT). Both sites of IMT were independently associated

with prevalent CVD, with the ICA IMT having a larger area under the ROC (receiver operating characteristic) curve than CCA IMT (0.756 vs. 0.695) [29]. Furthermore, evidence from a population-based study showed variation in the progression of IMT at different arterial sites [30]. Progression rate of ICA IMT was significantly greater compared to IMT in the bifurcation or in the common carotid artery. In addition, ICA IMT correlated better with vascular Smoothened risk factors than CCA IMT. The results suggest that ICA IMT might be a better measure of CVD than the more frequently investigated CCA IMT. Carotid plaque is a distinctive phenotype of atherosclerosis [14]. Carotid IMT, however, is mainly related to hypertension resulting in a hypertrophy of the media layer of the vessel wall [31]. There is evidence of genetic influence on cIMT, whereas carotid plaque is strongly influenced by environmental factors [14] and [32]. Although cIMT has been associated with increased risk of cardiovascular disease, carotid plaque is a stronger predictor of cardiovascular disease in large population-based studies [33]. Nevertheless, differentiation of early plaque formation from increased cIMT is hard to determine.