Predictive value for cardiovascular events of common carotid intima media thickness and its rate of change in individuals at high cardiovascular risk – Results from the PROG-IMT collaboration

Abstract

AimsCarotid intima media thickness (CIMT) predicts cardiovascular (CVD) events, but the predictive value of CIMT change is debated. We assessed the relation between CIMT change and events in individuals at high cardiovascular risk.Methods and resultsFrom 31 cohorts with two CIMT scans (total n = 89070) on average 3.6 years apart and clinical follow-up, subcohorts were drawn: (A) individuals with at least 3 cardiovascular risk factors without previous CVD events, (B) individuals with carotid plaques without previous CVD events, and (C) individuals with previous CVD events. Cox regression models were fit to estimate the hazard ratio (HR) of the combined endpoint (myocardial infarction, stroke or vascular death) per standard deviation (SD) of CIMT change, adjusted for CVD risk factors. These HRs were pooled across studies.In groups A, B and C we observed 3483, 2845 and 1165 endpoint events, respectively. Average common CIMT was 0.79mm (SD 0.16mm), and annual common CIMT change was 0.01mm (SD 0.07mm), both in group A. The pooled HR per SD of annual common CIMT change (0.02 to 0.43mm) was 0.99 (95% confidence interval: 0.95–1.02) in group A, 0.98 (0.93–1.04) in group B, and 0.95 (0.89–1.04) in group C. The HR per SD of common CIMT (average of the first and the second CIMT scan, 0.09 to 0.75mm) was 1.15 (1.07–1.23) in group A, 1.13 (1.05–1.22) in group B, and 1.12 (1.05–1.20) in group C.ConclusionsWe confirm that common CIMT is associated with future CVD events in individuals at high risk. CIMT change does not relate to future event risk in high-risk individuals.

High Burden of Subclinical Cardiovascular Target Organ Damage After Pediatric Liver Transplantation

“…Both IMT and PWV have been proven to be predictive of CV events in adults. (19,20) Only 3 studies have described IMT measurements in pediatric LT recipients of various ages and follow-up periods, albeit with differing results. Although Siirtola et al could not find a difference in IMT between pediatric transplant recipients (n = 9) and controls, (15) Roblin et al described IMT >2 standard deviation scores (SDSs) in 7 out of 31 patients.…”

“…PWV reflects arteriosclerosis, the loss of elasticity in medium or large arteries. Both IMT and PWV have been proven to be predictive of CV events in adults . Only 3 studies have described IMT measurements in pediatric LT recipients of various ages and follow‐up periods, albeit with differing results.…”

Carotid Artery Doppler Ultrasound and Coronary Calcium Score in Assessment of Atherosclerosis in Patients with Suspected Coronary Artery Disease

“…The literature has stated that such contradicting results are probably stemming from the differences in study design, differences techniques in CIMT measurements, such as measuring the common or internal segment and whether plaques are included or excluded from analyses, as covered in a review by Naqvi & Lee, 2014 [13] . Another explanation to such phenomenon is that CIMT is correlated positively & strongly with CVD risk, yet adding it to a prediction model with other CVD risk factors might not add to the score because of collinearity, specially that all the risk predictor in traditional risk are proven linear predictors of atherosclerosis and CIMT [14] .…”

Traditional Risk Factors are Causally Related to Carotid Intima-Media Thickness Progression: Inferences from Observational Cohort Studies and Interventional Trials

“…Utilization of study group averages instead of individual data has been viewed as one among a series of possible factors that might explain the failure of these metaregression analyses in demonstrating the expected ability of C-IMTp to predict clinical outcomes [177]. However, disappointing negative results were also reported in more recent meta-analyses of cohort studies in general populations [178], in patients with T2DM [179] and in high risk individuals [180] that, instead, computed individual data. In these latter studies, however, the analyses were focused on the relationship between clinical events and changes in IMT of the common carotid artery, which is the carotid segment more reproducibly assessed through vascular ultrasound but also the one less affected by atherosclerosis.…”