Intima-media thickness at the near or far wall of the common carotid artery in cardiovascular risk assessment
Seekircher, Lisa; Tschiderer, Lena; Lind, Lars; Safarova, Maya S.; Kavousi, Maryam; Ikram, M. Arfan; Lonn, Eva; Yusuf, Salim; Grobbee, Diederick E.; Kastelein, John J.P.; Visseren, Frank L.J.; Walters, Matthew; Dawson, Jesse; Higgins, Peter; Agewall, Stefan; Catapano, Alberico; De Groot, Eric; Espeland, Mark A.; Klingenschmid, Gerhard; Magliano, Dianna; Olsen, Michael H.; Preiss, David; Sander, Dirk; Skilton, Michael; Zozulińska-Ziółkiewicz, Dorota A.; Grooteman, Muriel P.C.; Blankestijn, Peter J.; Kitagawa, Kazuo; Okazaki, Shuhei; Manzi, Maria V.; Mancusi, Costantino; Izzo, Raffaele; Desvarieux, Moise; Rundek, Tatjana; Gerstein, Hertzel C.; Bots, Michiel L.; Sweeting, Michael J.; Lorenz, Matthias W.; Willeit, Peter
(2023) European heart journal open, volume 3, issue 5
(Article)
Abstract
Aims: Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive
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values. Methods and results: We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02 mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [r = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; I² = 30.7%) and 1.20 (1.18-1.23; I² = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; I² = 8.4%) and 1.14 (1.12-1.16; I²=1.3%) upon multivariable adjustment (all P < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near (P < 0.001), +0.0037 for far wall (P = 0.006)]. Conclusions: The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls.
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Keywords: Cardiovascular risk, Common carotid artery intima-media thickness, Individual-participant-data meta-analysis, Cardiology and Cardiovascular Medicine, Surgery, Journal Article
ISSN: 2752-4191
Publisher: Oxford University Press
Note: Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
(Peer reviewed)