Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study
Wang, Xin; Dalmeijer, Gerdien; Den Ruijter, Hester M.; Anderson, Todd J.; Britton, Annie R.; Dekker, Jacqueline; Engström, Gunnar; Evans, Greg W.; De Graaf, Jacqueline; Grobbee, Diederick E.; Hedblad, Bo; Holewijn, Suzanne; Ikeda, Ai; Kauhanen, Jussi; Kitagawa, Kazuo; Kitamura, Akihiko; Kurl, Sudhir; Lonn, Eva M.; Lorenz, Matthias W.; Mathiesen, Ellisiv B.; Nijpels, Giel; Okazaki, Shuhei; Polak, Joseph F.; Price, Jacqueline F.; Rembold, Christopher M.; Rosvall, Maria; Rundek, Tatjana; Salonen, Jukka T.; Sitzer, Matthias; Stehouwer, Coen D A; Tuomainen, Tomi Pekka; Peters, Sanne A E; Bots, Michiel L.
(2017) PLoS ONE [E], volume 12, issue 3
(Article)
Abstract
Background: The relation of a single risk factor with atherosclerosis is established. Clinically we know of risk factor clustering within individuals. Yet, studies into the magnitude of the relation of risk factor clusters with atherosclerosis are limited. Here, we assessed that relation. Methods: Individual participant data from 14 cohorts, involving
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59,025 individuals were used in this cross-sectional analysis. We made 15 clusters of four risk factors (current smoking, overweight, elevated blood pressure, elevated total cholesterol). Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) between clusters using those without any of the four risk factors as reference group. Results: Compared to the reference, those with 1, 2, 3 or 4 risk factors had a significantly higher common CIMT: mean difference of 0.026 mm, 0.052 mm, 0.074 mm and 0.114 mm, respectively. These findings were the same in men and in women, and across ethnic groups. Within each risk factor cluster (1, 2, 3 risk factors), groups with elevated blood pressure had the largest CIMT and those with elevated cholesterol the lowest CIMT, a pattern similar for men and women. Conclusion: Clusters of risk factors relate to increased common CIMT in a graded manner, similar in men, women and across race-ethnic groups. Some clusters seemed more atherogenic than others. Our findings support the notion that cardiovascular prevention should focus on sets of risk factors rather than individual levels alone, but may prioritize within clusters.
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Keywords: General Medicine, General Biochemistry,Genetics and Molecular Biology, General Agricultural and Biological Sciences, Journal Article
ISSN: 1932-6203
Publisher: Public Library of Science
Note: Funding Information: The USE-IMT-project is supported by a grant from the Netherlands Organisation for Health Research and Development (ZonMw 200320003). The Multi-Ethnic Study of Atherosclerosis (MESA) was supported by NIH contracts N01-HC-95159 to N01-HC-95167. Dr X Wang has been supported by a grant from the Chinese Scholarship Council. Dr GW Dalmeijer has been supported by a grant by the Dutch Heart Foundation 2013T084: Queen of Hearts. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2017 Wang et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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