2.3 Measurement of carotid intima-media thickness
To perform the carotid ultrasound (ClearVue 350, L12-14 transducer), the participant was placed in a supine position with the neck extended and turned 45 degrees contralaterally to the studied side. In a longitudinal projection, the carotid intima-media was defined as the hyperechoic space between the lumen intima and the media-adventitia, the two internal and hyperechoic layers of the artery wall. The measurement was performed in the area of the carotid intima-media with the largest diameter, excluding the presence of an atherosclerotic plaque, which is defined as a carotid intima-media thickness ≥2 mm.21-24
To validate carotid intima-media thickness measurements, we selected a sample of 20% of the total studied population for evaluation by another physician. To assess intrarater reliability, the principal radiologist carried out three baseline studies in the same participant on consecutive days. For inter-rater reliability, another operator evaluated each patient in the same way. They were always blinded to clinical and imaging information.