Dataset Information

Carotid plaque-thickness and common carotid IMT show additive value in cardiovascular risk prediction and reclassification.

ABSTRACT:

Background and aims

Carotid plaque size and the mean common carotid intima-media thickness measured in plaque-free areas (PF CC-IMT_mean) have been identified as predictors of vascular events (VEs), but their complementarity in risk prediction and stratification is still unresolved. The aim of this study was to evaluate the independence of carotid plaque thickness and PF CC-IMT_mean in cardiovascular risk prediction and risk stratification.

Methods

The IMPROVE-study is a European cohort (n = 3703), where the thickness of the largest plaque detected in the whole carotid tree was indexed as cIMT_max. PF CC-IMT_mean was also assessed. Hazard Ratios (HR) comparing the top quartiles of cIMT_max and PF CC-IMT_meanversus their respective 1-3 quartiles were calculated using Cox regression.

Results

After a 36.2-month follow-up, there were 215 VEs (125 coronary, 73 cerebral and 17 peripheral). Both cIMT_max and PF CC-IMT_mean were mutually independent predictors of combined-VEs, after adjustment for center, age, sex, risk factors and pharmacological treatment [HR (95% CI) = 1.98 (1.47, 2.67) and 1.68 (1.23, 2.29), respectively]. Both variables were independent predictors of cerebrovascular events (ischemic stroke, transient ischemic attack), while only cIMT_max was an independent predictor of coronary events (myocardial infarction, sudden cardiac death, angina pectoris, angioplasty, coronary bypass grafting). In reclassification analyses, PF CC-IMT_mean significantly adds to a model including both Framingham Risk Factors and cIMT_max (Integrated Discrimination Improvement; IDI = 0.009; p = 0.0001) and vice-versa (IDI = 0.02; p < 0.0001).

Conclusions

cIMT_max and PF CC-IMT_mean are independent predictors of VEs, and as such, they should be used as additive rather than alternative variables in models for cardiovascular risk prediction and reclassification.

SUBMITTER: Amato M

PROVIDER: S-EPMC5567407 | biostudies-literature | 2017 Aug

REPOSITORIES: biostudies-literature

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Publications

Carotid plaque-thickness and common carotid IMT show additive value in cardiovascular risk prediction and reclassification.

Amato Mauro M Veglia Fabrizio F de Faire Ulf U Giral Philippe P Rauramaa Rainer R Smit Andries J AJ Kurl Sudhir S Ravani Alessio A Frigerio Beatrice B Sansaro Daniela D Bonomi Alice A Tedesco Calogero C CC Castelnuovo Samuela S Mannarino Elmo E Humphries Steve E SE Hamsten Anders A Tremoli Elena E Baldassarre Damiano D

Atherosclerosis 20170519

<h4>Background and aims</h4>Carotid plaque size and the mean common carotid intima-media thickness measured in plaque-free areas (PF CC-IMT<sub>mean</sub>) have been identified as predictors of vascular events (VEs), but their complementarity in risk prediction and stratification is still unresolved. The aim of this study was to evaluate the independence of carotid plaque thickness and PF CC-IMT<sub>mean</sub> in cardiovascular risk prediction and risk stratification.<h4>Methods</h4>The IMPROVE- ...[more]

PMID: 28602434

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Project description:OBJECTIVES:Population statistics for carotid plaque and cardiovascular risk factors reported in scientific journals are usually presented as averages for the population or age and sex adjusted, rather than sex and age groups. Important population differences about atherosclerosis and cardiovascular risk factors may thus be missed. We compare the distribution of cardiovascular risk factors, carotids plaque and carotid intima-media thickness (CIMT) in two population-based studies. METHODS:Carotid artery atherosclerotic plaque prevalence and risk factors levels for cardiovascular disease by sex in 5-year age groups from the Risk Evaluation For Infarct Estimates Reykjavik study (REFINE-Reykjavik study) were compared with data from the Tromsø 6 study. RESULTS:The threshold of carotid plaque presence in the Tromsø 6 study fell between minimal and moderate plaque defined in the REFINE-Reykjavik study reflecting carotid plaque prevalence. The prevalence of minimal carotid plaque in the REFINE-Reykjavik study was 47% in men (40-69 years old) and 38% in women and 11% in men and 7% in women of moderate plaque. The prevalence of any plaque in the Tromsø 6 study was 35% in men and 27% in women. The mean (CIMT) was similar in the studies. In the Tromsø 6 study mean systolic blood pressure was 8 mm Hg higher in men and 10 mm Hg higher in women, mean low-density lipoprotein was 0.5 mmol/L higher in men and 0.3 mmol/L higher in women and the prevalence of smoking was 4% higher in men and 9% higher in women. However, body mass index was 0.8 kg/m2 higher in men and 0.9 kg/m2 in women in the REFINE-Reykjavik study. CONCLUSION:Comparison between Iceland and Norway revealed differences in the prevalence of carotid plaque, which was assumed to be due to different definition of plaque. However, clinically significant differences in conventional cardiovascular risk factors were seen. This underscores the importance of detailed comparison of population data across different populations.

Project description:BACKGROUND:Carotid intima-media thickness (cIMT) is related to the risk of cardiovascular events in the general population. An association between changes in cIMT and cardiovascular risk is frequently assumed but has rarely been reported. Our aim was to test this association. METHODS:We identified general population studies that assessed cIMT at least twice and followed up participants for myocardial infarction, stroke, or death. The study teams collaborated in an individual participant data meta-analysis. Excluding individuals with previous myocardial infarction or stroke, we assessed the association between cIMT progression and the risk of cardiovascular events (myocardial infarction, stroke, vascular death, or a combination of these) for each study with Cox regression. The log hazard ratios (HRs) per SD difference were pooled by random effects meta-analysis. FINDINGS:Of 21 eligible studies, 16 with 36,984 participants were included. During a mean follow-up of 7·0 years, 1519 myocardial infarctions, 1339 strokes, and 2028 combined endpoints (myocardial infarction, stroke, vascular death) occurred. Yearly cIMT progression was derived from two ultrasound visits 2-7 years (median 4 years) apart. For mean common carotid artery intima-media thickness progression, the overall HR of the combined endpoint was 0·97 (95% CI 0·94-1·00) when adjusted for age, sex, and mean common carotid artery intima-media thickness, and 0·98 (0·95-1·01) when also adjusted for vascular risk factors. Although we detected no associations with cIMT progression in sensitivity analyses, the mean cIMT of the two ultrasound scans was positively and robustly associated with cardiovascular risk (HR for the combined endpoint 1·16, 95% CI 1·10-1·22, adjusted for age, sex, mean common carotid artery intima-media thickness progression, and vascular risk factors). In three studies including 3439 participants who had four ultrasound scans, cIMT progression did not correlate between occassions (reproducibility correlations between r=-0·06 and r=-0·02). INTERPRETATION:The association between cIMT progression assessed from two ultrasound scans and cardiovascular risk in the general population remains unproven. No conclusion can be derived for the use of cIMT progression as a surrogate in clinical trials. FUNDING:Deutsche Forschungsgemeinschaft.

Dataset Information

Carotid plaque-thickness and common carotid IMT show additive value in cardiovascular risk prediction and reclassification.

Background and aims

Methods

Results

Conclusions

Publications

Carotid plaque-thickness and common carotid IMT show additive value in cardiovascular risk prediction and reclassification.

Similar Datasets

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