Heritability of the femoral intima media thickness

Published:February 22, 2017DOI:


      • Common and superficial femoral IMT is heritable in 44% to 47%.
      • No substantial common environmental influence was found.
      • The highest variance was attributable to unique environmental factors.
      • The heritability is not modified by obesity and smoking.



      The measurement of femoral intima-media thickness (IMT) is underutilized in the clinical practice, although it is a surrogate marker of cardiovascular disease.

      Materials and methods

      388 Hungarian and Italian twins (121 monozygotic, 73 dizygotic pairs) underwent bilateral B-mode sonography of femoral arteries. IMT was measured by semiautomated software, where available, or by calipers.


      Within-pair correlation in monozygotic twins was higher than in dizygotics for each parameter. Age-, sex- and country-adjusted genetic effect accounted for 43.9% (95% confidence interval, CI 21.3%–65.2%) and 47.2% (95% CI, 31.4%–62.6%) of the variance of common and superficial femoral artery IMT, respectively, and unshared environmental effect for 56.1% (95% CI 34.6%–78.5%) and 52.8% (95% CI, 37.2%–68.5%). These results did not change significantly after correcting for body mass index or central systolic blood pressure.


      Genetic factors have a moderate role in the determination of common and superficial femoral IMT; however, the influence of environmental (lifestyle) factors remains still relevant. Environmental factors may have a role in influencing the genetic predisposition for femoral vascular hypertrophy.



      BMI (body mass index), MZ (monozygotic), DZ (dizygotic), CCA (common carotid artery), CFA (common femoral artery), SFA (superficial femoral artery), IMT (intima media thickness), SBP (systolic blood pressure), DBP (diastolic blood pressure), A (additive genetics (heritability)), C (shared environmental variance component), E (unique environmental variance component), AIC (Akaike information criteria), BIC (Bayesian information criteria), LL (log likelihood)
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        • Hirsch A.T.
        • Criqui M.H.
        • Treat-Jacobson D.
        • Regensteiner J.G.
        • Creager M.A.
        • Olin J.W.
        • et al.
        Peripheral arterial disease detection, awareness, and treatment in primary care.
        JAMA. 2001; 286: 1317-1324
        • Belch J.J.F.
        • Topol E.J.
        • Agnelli G.
        • Bertrand M.
        • Califf R.M.
        • Clement D.L.
        • et al.
        Prevention of Atherothrombotic Disease Network. Critical issues in peripheral arterial disease detection and management: a call to action.
        Arch Intern Med. 2003; 163: 884-892
        • Diehm C.
        • Allenberg J.R.
        • Pittrow D.
        • Mahn M.
        • Tepohl G.
        • Haberl R.L.
        • et al.
        German Epidemiological Trial on Ankle Brachial Index Study Group. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease.
        Circulation. 2009; 120: 2053-2061
        • Cheng K.S.
        • Mikhailidis D.P.
        • Hamilton G.
        • Seifalian A.M.
        A review of the carotid and femoral intima-media thickness as an indicator of the presence of peripheral vascular disease and cardiovascular risk factors.
        Cardiovasc Res. 2002; 54: 528-538
        • Giannoukas A.D.
        • Antoniou G.A.
        • Saleptsis V.
        • Baros C.
        • Griffin M.
        • Nicolaides A.N.
        Common femoral artery intima-media thickness as marker for cardiovascular disease in asymptomatic adults.
        Vasa. 2009; 38: 147-154
        • Sosnowski C.
        • Pasierski T.
        • Janeczko-Sosnowska E.
        • Szulczyk A.
        • Dabrowski R.
        • Woźniak J.
        • et al.
        Femoral rather than carotid artery ultrasound imaging predicts extent and severity of coronary artery disease.
        Kardiol Pol. 2007; 65: 760-766
        • Neiva Neto E.C.
        • Piatto M.J.
        • Paschôa A.F.
        • Godoy Ide B.
        • Schlaad S.W.
        • Van Bellen B.
        Intima-media thickness: correlation between carotids, vertebral artery, aorta and femoral arteries.
        Int Angiol. 2015; 34: 269-275
        • Kirhmajer M.V.
        • Banfic L.
        • Vojkovic M.
        • Strozzi M.
        • Bulum J.
        • Miovski Z.
        Correlation of femoral intima-media thickness and the severity of coronary artery disease.
        Angiology. 2011; 62: 134-139
        • Selvin E.
        • Erlinger T.P.
        Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000.
        Circulation. 2004; 110: 738-743
        • Littvay L.
        • Métneki J.
        • Tárnoki A.D.
        • Tárnoki D.L.
        The Hungarian Twin Registry.
        Twin Res Hum Genet. 2013; 16: 185-189
        • Brescianini S.
        • Fagnani C.
        • Toccaceli V.
        • Medda E.
        • Nisticò L.
        • D'Ippolito C.
        • et al.
        An update on the Italian Twin Register: advances in cohort recruitment, project building and network development.
        Twin Res Hum Genet. 2013; 16: 190-196
        • Maurovich-Horvat P.
        • Tárnoki D.L.
        • Tárnoki Á.D.
        • Horváth T.
        • Jermendy Á.L.
        • Kolossváry M.
        • et al.
        Rationale, design, and methodological aspects of the BUDAPEST-GLOBAL Study (burden of atherosclerotic plaques study in twins-genetic loci and the burden of atherosclerotic lesions).
        Clin Cardiol. 2015; 38: 699-707
        • Heath A.C.
        • Nyholt D.R.
        • Neuman R.
        • Madden P.A.
        • Bucholz K.K.
        • Todd R.D.
        • et al.
        Zygosity diagnosis in the absence of genotypic data: an approach using latent class analysis.
        Twin Res. 2003; 6: 22-26
        • Bots M.L.
        • Hofman A.
        • Grobbee D.E.
        Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study.
        Arterioscler Thromb. 1994; 14: 1885-1891
        • Neale M.C.
        • Cardon L.R.
        North Atlantic Treaty Organization.
        in: Methodology for Genetic Studies of Twins and Families. Kluwer Academic Publishers, Dordrecht, ZH, The Netherlands1992
        • Jinks J.L.
        • Fulker D.W.
        Comparison of the biometrical genetical, MAVA, and classical approaches to the analysis of human behavior.
        Psychol Bull. 1970; 73: 311-349
        • Bollen K.A.
        • Stine R.A.
        Bootstrapping goodness-of-fit measures in structural equation models.
        Sociol Methods Res. 1992; 201: 205-229
        • Falconer D.S.
        • MacKay T.S.C.
        Introduction to quantitative genetics.
        Longmans Green, Harlow1996
        • Health Quality Ontario
        Stenting for peripheral artery disease of the lower extremities: an evidence-based analysis.
        Ont Health Technol Assess Ser. 2010; 10: 1-88
        • Norgren L.
        • Hiatt W.R.
        • Dormandy J.A.
        • Nehler M.R.
        • Harris K.A.
        • Fowkes F.G.
        • et al.
        Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II).
        Eur J Vasc Endovasc Surg. 2007; 33 (Suppl 1): S1-75
        • McDermott M.M.
        • Lloyd-Jones D.M.
        The role of biomarkers and genetics in peripheral arterial disease.
        J Am Coll Cardiol. 2009; 54: 1228-1237
        • Lee K.
        • Sung J.
        • Lee S.C.
        • Park S.W.
        • Kim Y.S.
        • Lee J.Y.
        • et al.
        Phenotypic and genetic relationships between kidney function and carotid intima-media thickness in Koreans: the Healthy Twin Study.
        Kidney Blood Press Res. 2012; 35: 259-264
        • Medda E.
        • Fagnani C.
        • Schillaci G.
        • Tarnoki A.D.
        • Tarnoki D.L.
        • Baracchini C.
        • et al.
        Heritability of arterial stiffness and carotid intima-media thickness: an Italian twin study.
        Nutr Metab Cardiovasc Dis. 2014; 24: 511-517
        • Kasliwal R.R.
        • Bansal M.
        • Desai D.
        • Sharma M.
        Carotid intima-media thickness: current evidence, practices, and Indian experience.
        Indian J Endocrinol Metab. 2014; 18: 13-22
        • Lucatelli P.
        • Fagnani C.
        • Tarnoki A.D.
        • Tarnoki D.L.
        • Stazi M.A.
        • Salemi M.
        • et al.
        Femoral Artery Ultrasound Examination: A New Role in Predicting Cardiovascular Risk.
        Angiology. 2016 May 27; (pii: 0003319716651777. [Epub ahead of print])
        • O'Leary D.H.
        • Polak J.F.
        • Kronmal R.A.
        • Manolio T.A.
        • Burke G.L.
        • Wolfson Jr., S.K.
        Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group.
        N Engl J Med. 1999; 340: 14-22
        • Rainwater D.L.
        • Shi Q.
        • Mahaney M.C.
        • Hodara V.
        • Vandeberg J.L.
        • Wang X.L.
        Genetic regulation of endothelial inflammatory responses in baboons.
        Arterioscler Thromb Vasc Biol. 2010; 30: 1628-1633
        • Cecelja M.
        • Jiang B.
        • Bevan L.
        • Frost M.L.
        • Spector T.D.
        • Chowienczyk P.J.
        Arterial stiffening relates to arterial calcification but not to noncalcified atheroma in women. A twin study.
        J Am Coll Cardiol. 2011; 57: 1480-1486
        • Meyer W.W.
        • Lind J.
        • Yao A.C.
        • Kauffman S.L.
        Early arterial lesions in infancy and childhood and ways of prevention.
        Paediatrician. 1982; 11: 136-156
        • Kiechl S.
        • Werner P.
        • Egger G.
        • Oberhollenzer F.
        • Mayr M.
        • Xu Q.
        • et al.
        Active and passive smoking, chronic infections, and the risk of carotid atherosclerosis: prospective results from the Bruneck Study.
        Stroke. 2002; 33: 2170-2176