Cardiovascular disease (CVD) prevention is defined as a coordinated set ofactions, at the population level or targeted at an individual, that are aimed ateliminating or minimizing the impact of CVDs and their relateddisabilities.¹CVD remains a leading cause of morbidity and mortality, despite improvements inoutcomes. Age-adjusted coronary artery disease (CAD) mortality has declinedsince the 1980s, particularly in high-income regions.² CAD rates are now less than half what theywere in the early 1980s in many countries in Europe, due to preventive measuresincluding the success of smoking legislation. However, inequalities betweencountries persist and many risk factors, particularly obesity³ and diabetes mellitus(DM),⁴ have beenincreasing substantially. If prevention was practised as instructed it wouldmarkedly reduce the prevalence of CVD. It is thus not only prevailing riskfactors that are of concern, but poor implementation of preventive measures aswell.^5,6 Prevention should bedelivered (i) at the general population level by promoting healthy lifestylebehaviour⁷ and(ii) at the individual level, i.e. in those subjects at moderate to high risk ofCVD or patients with established CVD, by tackling unhealthy lifestyles (e.g.poor-quality diet, physical inactivity, smoking) and by optimising risk factors.Prevention is effective: the elimination of health risk behaviours would make itpossible to prevent at least 80% of CVDs and even 40% of cancers.^8,9

Background and Purpose— Ultrasound of carotid arteries provides measures of intima media thickness (IMT) and plaque, both widely used as surrogate measures of cardiovascular disease. Although IMT and plaques are highly intercorrelated, the relationship between carotid plaque and IMT and cardiovascular disease has been conflicting. In this prospective, population-based study, we measured carotid IMT, total plaque area, and plaque echogenicity as predictors for first-ever myocardial infarction (MI). Methods— IMT, total plaque area, and plaque echogenicity were measured in 6226 men and women aged 25 to 84 years with no previous MI. The subjects were followed for 6 years and incident MI was registered. Results— During follow-up, MI occurred in 6.6% of men and 3.0% of women. The adjusted relative risk (RR; 95% CI) between the highest plaque area tertile versus no plaque was 1.56 (1.04 to 2.36) in men and 3.95 (2.16 to 7.19) in women. In women, there was a significant trend toward a higher MI risk with more echolucent plaque. The adjusted RR (95% CI) in the highest versus lowest IMT quartile was 1.73 (0.98 to 3.06) in men and 2.86 (1.07 to 7.65) in women. When we excluded bulb IMT from analyses, IMT did not predict MI in either sex. Conclusions— In a general population, carotid plaque area was a stronger predictor of first-ever MI than was IMT. Carotid atherosclerosis was a stronger risk factor for MI in women than in men. In women, the risk of MI increased with plaque echolucency.

Background and Purpose—: Carotid plaque and intima-media thickness (IMT) are recognized as risk factors for ischemic stroke, but their predictive value has been debated and varies between studies. The purpose of this longitudinal population-based study was to assess the risk of ischemic stroke associated with plaque area and IMT in the carotid artery. Methods—: IMT and total plaque area in the right carotid artery were measured with ultrasound in 3240 men and 3344 women aged 25 to 84 years who participated in a population health study in 1994 to 1995. First-ever ischemic strokes were identified through linkage to hospital and national diagnosis registries, with follow-up until December 31, 2005. Results—: Incident ischemic strokes occurred in 7.3% (n=235) of men and 4.8% (n=162) of women. The hazard ratio for 1 SD increase in square-root-transformed plaque area was 1.23 (95% CI, 1.09–1.38; P =0.0009) in men and 1.19 (95% CI, 1.01–1.41; P =0.04) in women when adjusted for other cardiovascular risk factors. The multivariable-adjusted hazard ratio in the highest quartile of plaque area versus no plaque was 1.73 (95% CI, 1.19–2.52; P =0.004) in men and 1.62 (95% CI, 1.04–2.53; P =0.03) in women. The multivariable-adjusted hazard ratio for 1 SD increase in IMT was 1.08 (95% CI, 0.95–1.22; P =0.2) in men and 1.24 (95% CI, 1.05–1.48; P =0.01) in women. There were no differences in stroke risk across quartiles of IMT in multivariable analysis. Conclusions—: In the present study, total plaque area appears to be a stronger predictor than IMT for first-ever ischemic stroke.