Cardiovascular diseases (CVDs), particularly coronary artery disease (CAD), remain the leading cause of mortality and morbidity worldwide, accounting for nearly 17.9 million deaths annually as per the World Health Organization [1]. In India, the burden of CAD is increasing steadily due to rapid urbanization, lifestyle changes, and an aging population [2]. The disease often remains clinically silent until it presents as an acute event such as myocardial infarction, highlighting the importance of early detection and risk stratification [3].

Atherosclerosis, the underlying pathology in CAD, is a chronic inflammatory condition characterized by the accumulation of lipids, fibrous tissue, and inflammatory cells within the arterial walls [4]. Importantly, atherosclerotic changes occur systemically, affecting not only the coronary arteries but also peripheral vessels such as the carotid arteries. Therefore, non-invasive assessment of peripheral arteries—especially the common carotid artery—provides an indirect yet reliable estimation of systemic atherosclerotic burden. Carotid intima-media thickness (CIMT), measured by B-mode ultrasonography, has been recognized as a surrogate marker of early atherosclerosis and cardiovascular risk [5,6].

Several studies have demonstrated a significant association between increased CIMT and the presence or severity of CAD [7,8]. The American Society of Echocardiography supports the clinical utility of CIMT for cardiovascular risk assessment, particularly among individuals with intermediate risk profiles where traditional risk factors may not offer sufficient predictive power [9]. Despite its promise, CIMT is not yet widely adopted in routine clinical practice, and its predictive accuracy continues to be evaluated in different populations and clinical settings [10].

This study was conducted to assess the association between CIMT and angiographically confirmed CAD among patients presenting to a tertiary care hospital. By comparing CIMT values between patients with CAD and age-matched healthy controls, the study aims to determine the diagnostic and prognostic relevance of CIMT as a non-invasive tool for early identification of coronary atherosclerosis.

This was a hospital-based, prospective, case-control study conducted in the Department of Medicine at MGM Medical College and Hospital, Kamothe, Navi Mumbai. The study included a total of 100 participants, divided into two groups: 50 patients with angiographically confirmed coronary artery disease (CAD group) and 50 healthy age- and sex-matched individuals without CAD (control group). Ethical approval was obtained from the Institutional Ethics Committee prior to study initiation, and informed consent was taken from all participants. Inclusion criteria for the CAD group consisted of adults aged 30 to 70 years with confirmed CAD based on coronary angiography findings. The control group included individuals with no clinical or angiographic evidence of CAD, free from significant comorbid conditions such as diabetes, hypertension, or dyslipidemia. Exclusion criteria were pregnancy, known history of stroke, peripheral vascular disease, valvular heart disease, or systemic inflammatory disorders.

Carotid intima-media thickness (CIMT) was measured using high-resolution B-mode ultrasonography with a 7.5 MHz linear array transducer. The measurements were taken at three sites on both the right and left common carotid arteries—1 cm proximal to the carotid bifurcation—while the subject was in the supine position. The mean of six readings was calculated and recorded as the final CIMT value for each participant. Additional investigations included fasting lipid profile, blood glucose levels, and body mass index (BMI). Data were analyzed using IBM SPSS Statistics Version 26.0. Descriptive statistics, Student’s t-test, and Chi-square tests were applied where appropriate, and a p-value <0.05 was considered statistically significant.

This case-control study analyzed 100 participants (50 CAD cases and 50 controls) to assess the association between carotid intima-media thickness (CIMT) and coronary artery disease. Differences in clinical, biochemical, and imaging parameters were evaluated, along with the relationship of CIMT to common cardiovascular risk factors.

The study groups were comparable in gender and age distribution. Among cases, obesity (44%) was more prevalent compared to controls (28%), while overweight was more common in controls (46%). Most CAD cases had single (48%) or double (42%) vessel involvement, with only 10% showing more than two vessels affected. (Table 1)

Elevated levels of cardiac biomarkers were observed only among CAD cases, with 66% showing raised Troponin T and 38% having elevated CPK-MB. All controls had normal levels for both markers, indicating a strong association of these biomarkers with coronary artery disease. (Table 2)

Significant differences were observed between CAD cases and controls in several clinical and biochemical parameters. Cases had higher systolic and diastolic blood pressure, fasting blood sugar, and significantly elevated lipid levels (total cholesterol, triglycerides, LDL, and VLDL). Hemoglobin, HbA1c, HDL, and most liver/renal function tests showed no significant difference, except for alkaline phosphatase, which was slightly higher in cases. Intima-media thickness (CIMT) was markedly elevated in CAD cases, supporting its role as a marker of atherosclerosis. (Table 3)

The comparison of carotid intima-media thickness (CIMT) across different clinical subgroups revealed several important associations. Firstly, a clear and statistically significant increase in CIMT was observed with the severity of coronary artery disease. Patients with single-vessel disease had a mean CIMT of 0.78 ± 0.21 mm, which increased to 1.71 ± 0.43 mm in double-vessel disease and further to 1.93 ± 0.12 mm in those with more than two vessels involved. This progressive rise in CIMT with advancing coronary involvement (p < 0.001) suggests that CIMT is a reliable surrogate marker for the extent of coronary atherosclerosis. The study also demonstrated that patients with diabetes had significantly higher CIMT values (1.16 ± 0.59 mm) compared to non-diabetic individuals (0.92 ± 0.46 mm), with a p-value of 0.03. This finding supports existing literature indicating that diabetes accelerates atherosclerotic changes, contributing to increased vascular wall thickness. Similarly, hypertensive patients showed significantly elevated CIMT (1.11 ± 0.57 mm) compared to normotensive individuals (0.88 ± 0.43 mm; p = 0.02), reinforcing the role of elevated blood pressure in vascular remodeling and early atherosclerosis. A strong association was also seen between smoking status and CIMT. Smokers had markedly higher CIMT (1.27 ± 0.75 mm) than non-smokers (0.84 ± 0.39 mm), and this difference was statistically significant (p < 0.001). This finding reflects the damaging effect of tobacco on endothelial function and its role in promoting intimal thickening. In contrast, no significant differences in CIMT were observed with respect to gender or age. Male participants had a mean CIMT of 1.03 ± 0.47 mm, while females had 0.98 ± 0.52 mm (p = 0.29), suggesting no gender-based difference in CIMT in this cohort. Similarly, CIMT did not significantly differ between the 30–45 years age group (1.39 ± 0.62 mm) and the 45–60 years group (1.24 ± 0.57 mm), indicating that within this age range, age alone may not be a strong determinant of CIMT (p = 0.53).

Overall, the analysis underscores the strong relationship between increased CIMT and modifiable cardiovascular risk factors such as diabetes, hypertension, smoking, and the anatomical severity of CAD, thereby highlighting its clinical utility in risk stratification and early detection of atherosclerosis. (Table 4)

CIMT showed a moderate positive correlation with total cholesterol (r = 0.44) and LDL (r = 0.24), both statistically significant (p < 0.001), indicating their contributory role in atherosclerosis. A weak but significant correlation was also noted with triglycerides (r = 0.04, p < 0.001). No significant association was found between CIMT and VLDL or HDL, suggesting a limited or inconsistent impact of these lipids on carotid wall thickness in this population. (Table 5)

Coronary artery disease (CAD) remains the leading cause of cardiovascular mortality globally, responsible for approximately 17.9 million deaths annually as per the World Health Organization [1]. In India, the burden of CAD is rising due to urbanization, sedentary lifestyles, and the growing prevalence of metabolic disorders such as diabetes and hypertension [2]. Atherosclerosis, the underlying pathology of CAD, is a chronic inflammatory condition affecting both coronary and peripheral arteries [3,4]. Consequently, non-invasive assessment of peripheral vasculature—particularly carotid intima-media thickness (CIMT)—has gained attention as a surrogate marker for subclinical atherosclerosis.

Our study demonstrated a statistically significant increase in CIMT among patients with angiographically proven CAD when compared to healthy age- and sex-matched controls (1.29 ± 0.58 mm vs. 0.70 ± 0.13 mm, p < 0.001). This finding supports the results of large prospective studies such as the ARIC and Rotterdam studies, which linked higher CIMT values with increased risk of myocardial infarction and stroke [5,6]. A meta-analysis by Lorenz et al. further validated CIMT as a predictor of cardiovascular events, reinforcing its clinical utility in risk stratification [7].

Additionally, the severity of coronary involvement was positively correlated with CIMT. Patients with single, double, and more than two vessel disease had mean CIMT values of 0.78 mm, 1.71 mm, and 1.93 mm, respectively (p < 0.001), suggesting that CIMT reflects not only the presence but also the extent of coronary atherosclerosis. This is in concordance with the findings of Baldassarre et al., who reported that increased CIMT is associated with more extensive coronary artery involvement [8]. These results highlight the potential of CIMT to act as a gradational marker for CAD severity.

Traditional risk factors such as diabetes, hypertension, and smoking were also associated with significantly higher CIMT values in our study. These findings align with the INTERHEART study, which showed that modifiable risk factors—including blood pressure, dyslipidemia, and tobacco use—contribute substantially to the global burden of myocardial infarction [3]. On the other hand, no significant differences in CIMT were observed with regard to age or gender, possibly due to the matched study design. However, previous research has shown that CIMT increases with age and tends to be slightly higher in males [10].

Moreover, CIMT was found to have a moderate positive correlation with total cholesterol and LDL cholesterol, further supporting its association with lipid-related atherogenic processes. These associations are well documented in earlier studies and provide a mechanistic explanation for the vascular thickening observed in dyslipidemic individuals [4,7]. Despite its promise, CIMT measurement is not yet routinely used in clinical practice. However, professional societies such as the American Society of Echocardiography endorse its use, especially in individuals with intermediate cardiovascular risk where traditional markers may be insufficient [9].

This study establishes a significant association between increased carotid intima-media thickness (CIMT) and the presence and severity of coronary artery disease (CAD). CIMT was notably higher in patients with CAD and further elevated in those with multiple vessel involvement. Traditional risk factors like diabetes, hypertension, and smoking were also linked to higher CIMT values. These findings support the role of CIMT as a valuable, non-invasive marker for early detection and risk stratification in CAD.

Funding Statement: No external funding was received for the conduct of this study.

Conflict of Interest: The authors declare no conflict of interest related to this study.

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