Reliability of B-mode ultrasound measurement of carotid intima-media thickness in assessing cardiovascular risk: a cross-sectional study

Objective: Carotid intima-media thickness (CIMT) is considered a marker of subclinical atherosclerosis; however, its reliability in predicting cardiovascular risk across different populations remains controversial. This study aimed to evaluate the correlation between B-mode ultrasound-measured CIMT and traditional cardiovascular risk scoring systems, and to investigate its value as a marker of cardiovascular risk. Methods: This cross-sectional study included 328 asymptomatic adults (excluding those with established cardiovascular disease). High-resolution B-mode ultrasound was used to measure CIMT bilaterally in the common carotid artery (CCA), carotid bulb, and internal carotid artery (ICA), and to calculate mean and maximum CIMT values. The Framingham Risk Score (FRS) and Pooled Cohort Equations (PCE) were computed, and data on traditional cardiovascular risk factors were collected. Pearson or Spearman correlation analyses, ROC curve analysis, and multivariate regression analysis were used to assess the relationship between CIMT and cardiovascular risk. Results: < 0.001).Multivariate analysis demonstrated that mean CIMT (OR = 1.46, 95% CI: 1.23-1.72) and maximum CIMT (OR = 1.58, 95% CI: 1.31-1.91) were independently associated with high cardiovascular risk categories as defined by FRS and PCE after adjusting for traditional risk factors. ROC curve analysis revealed that maximum CIMT had an AUC of 0.79 (95% CI: 0.73-0.85) for identifying high FRS risk (>20%) and an AUC of 0.76 (95% CI: 0.70-0.82) for identifying high PCE risk (>7.5%). Conclusion: B-mode ultrasound-measured CIMT significantly correlates with traditional cardiovascular risk scores and is independently associated with high cardiovascular risk categories after adjustment for traditional risk factors. CIMT measurements of the carotid bulb appear to show stronger correlation with risk scores than common carotid artery measurements. CIMT demonstrates correlation with established risk scoring systems and shows the most significant risk reclassification effect in intermediate-risk populations, supporting its potential utility as a complementary assessment tool.