TOPLINE

Higher carotid intima-media thickness (cIMT) values were associated with the enlargement of the aorta and cardiac chambers and impaired atrial and left ventricular function in people without established cardiovascular disease, and cIMT shared a common genetic architecture with structural cardiovascular changes.

METHODOLOGY

• Researchers conducted an integrative epidemiologic and genetic analysis using imaging and genetic data from the UK Biobank and large-scale genome-wide association studies to evaluate the association of cIMT with aortic and cardiac remodelling and subsequent cardiovascular outcomes.
• The analysis included 46,102 participants (mean age, 64.4-65.7 years; 51.2% women) without known cardiovascular disease who underwent both cardiac MRI and carotid ultrasound imaging.
• Carotid ultrasound scans were taken at multiple angles following a standard UK Biobank protocol; automated analysis generated mean cIMT values and flagged any plaques, with routine quality checks.
• Cardiac MRI scans were analysed with validated automated segmentation algorithms to map the aorta and all four cardiac chambers and to generate detailed structural and functional measures.
• The researchers performed genetic analyses to examine the shared genetics between cIMT and aortic and cardiac traits to shed light on early molecular and structural pathways linking subclinical atherosclerosis to later heart disease.

TAKEAWAY

• Higher left and right mean cIMT values were consistently associated with larger aortic cross-sectional areas, an increased cardiac chamber size, and greater atrial and ventricular volumes (P < .001 for all).
• Increased cIMT values were associated with lower left and right atrial ejection fractions (P < .001) and reduced left ventricular ejection fraction (P < .001); a modest association was seen between higher right cIMT values and lower right ventricular ejection fraction (P = .037), whereas no association was observed between left cIMT and right ventricular ejection fraction.
• Higher left cIMT values were associated with a 52.5% lower risk for dilated cardiomyopathy (P = .04); however, no significant associations were observed for atrial fibrillation, heart failure, or hypertrophic obstructive cardiomyopathy.
• Genetic analyses revealed a shared heritable architecture between cIMT and cardiovascular remodelling, particularly descending aortic diameter, left ventricular mass and wall thickness, and left atrial ejection fraction, and identified seven overlapping genes involved in pathways related to vascular and cardiac development, extracellular matrix organisation, and tissue remodelling.

IN PRACTICE

"[The study] findings suggest that routine cIMT assessment in high-risk individuals may enable earlier identification of subclinical cardiac remodeling before overt CVD [cardiovascular disease] becomes clinically manifest, supporting its potential utility as an early, noninvasive biomarker for risk stratification, surveillance, and preventive intervention," the researchers of the study wrote.

SOURCE

The study was led by Si Hui Chong, MSc, University College London, London, England. It was published online on July 03, 2026, in the Journal of the American Heart Association.

LIMITATIONS

The UK Biobank cohort comprised predominantly healthy, less deprived, middle-aged to older volunteers, which may have limited the generalisability of the findings. The cross-sectional study design could not establish cause and effect relationships. Genetic analysis was constrained by small genetic effects, differences in measurements, and heterogeneity across traits, which may have reduced the ability to detect and interpret associations.

DISCLOSURES

The study was supported by the British Heart Foundation, National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, and European Union Horizon scheme. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.