03965nas a2200493 4500008004100000022001400041245019200055210006900247260001600316300001200332490000800344520243000352653002802782653003502810653002402845653002202869653001102891653002602902653001402928653002002942653001102962100002402973700002102997700002003018700002603038700001903064700002603083700001703109700002303126700002603149700002803175700001903203700002003222700002303242700001503265700002103280700002803301700001203329700002503341700002103366700002303387710002503410856003603435 2012 eng d a1474-547X00aCarotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data.0 aCarotid intimamedia thickness progression to predict cardiovascu c2012 Jun 02 a2053-620 v3793 a

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.

10aCardiovascular Diseases10aCarotid Intima-Media Thickness10aDisease Progression10aFollow-Up Studies10aHumans10aMyocardial Infarction10aPrognosis10aRisk Assessment10aStroke1 aLorenz, Matthias, W1 aPolak, Joseph, F1 aKavousi, Maryam1 aMathiesen, Ellisiv, B1 aVölzke, Henry1 aTuomainen, Tomi-Pekka1 aSander, Dirk1 aPlichart, Matthieu1 aCatapano, Alberico, L1 aRobertson, Christine, M1 aKiechl, Stefan1 aRundek, Tatjana1 aDesvarieux, Moïse1 aLind, Lars1 aSchmid, Caroline1 aDasMahapatra, Pronabesh1 aGao, Lu1 aZiegelbauer, Kathrin1 aBots, Michiel, L1 aThompson, Simon, G1 aPROG-IMT Study Group uhttps://chs-nhlbi.org/node/1382