TY - JOUR
T1 - Measurements of carotid intima-media thickness and of interadventitia common carotid diameter improve prediction of cardiovascular events
T2 - Results of the IMPROVE (carotid intima media thickness [IMT] and IMT-progression as predictors of vascular events in a high risk European population) study
AU - Baldassarre, Damiano
AU - Hamsten, Anders
AU - Veglia, Fabrizio
AU - De Faire, Ulf
AU - Humphries, Steve E.
AU - Smit, Andries J.
AU - Giral, Philippe
AU - Kurl, Sudhir
AU - Rauramaa, Rainer
AU - Mannarino, Elmo
AU - Grossi, Enzo
AU - Paoletti, Rodolfo
AU - Tremoli, Elena
PY - 2012/10/16
Y1 - 2012/10/16
N2 - Objectives: The goal of this study was to compare the performance of several measures of carotid intima-media thickness (C-IMT) as predictors of cardiovascular events (CVEs), and to investigate whether they add to the predictive accuracy of Framingham risk factors (FRFs). Background: Various markers of subclinical atherosclerosis have been identified as predictors of CVEs, but the most powerful variable is still under debate. Methods: A cohort study was carried out in 5 European countries. A total of 3,703 subjects (median age 64.4 years; 48% men) were followed-up for a median of 36.2 months, and 215 suffered a first CVE (incidence: 19.9/1,000 person-years). Results: All measures of C-IMT and the interadventitia common carotid artery diameter (ICCAD) were associated with the risk of CVEs, after adjustment for FRFs and therapies (all p <0.005). The average of 8 maximal IMT measurements (IMTmean-max) , alone or combined with ICCAD, classified events and non-events better than the common carotid mean IMT (net reclassification improvement [NRI]: +11.6% and +19.9%, respectively; both p <0.01). Compared with classification based on FRFs alone, the NRI resulting from the combination of FRFs+ICCAD+IMT mean-max was +12.1% (p <0.01). The presence of at least 1 plaque (maximum IMT >1.5 mm) performed significantly worse than composite IMTs that incorporated plaques (p <0.001). Adjusted Kaplan-Meier curves showed that individuals with a FRS = 22.6% (cohort average), and both IMTmean-max and ICCAD above the median, had a 6.5% risk to develop a CVE over 3 years versus a 3.4% risk for those with the same FRS, and both IMTmean-max and ICCAD below the median. Conclusions: A risk stratification strategy based on C-IMT and ICCAD as an adjunct to FRFs is a rational approach to prevention of cardiovascular disease.
AB - Objectives: The goal of this study was to compare the performance of several measures of carotid intima-media thickness (C-IMT) as predictors of cardiovascular events (CVEs), and to investigate whether they add to the predictive accuracy of Framingham risk factors (FRFs). Background: Various markers of subclinical atherosclerosis have been identified as predictors of CVEs, but the most powerful variable is still under debate. Methods: A cohort study was carried out in 5 European countries. A total of 3,703 subjects (median age 64.4 years; 48% men) were followed-up for a median of 36.2 months, and 215 suffered a first CVE (incidence: 19.9/1,000 person-years). Results: All measures of C-IMT and the interadventitia common carotid artery diameter (ICCAD) were associated with the risk of CVEs, after adjustment for FRFs and therapies (all p <0.005). The average of 8 maximal IMT measurements (IMTmean-max) , alone or combined with ICCAD, classified events and non-events better than the common carotid mean IMT (net reclassification improvement [NRI]: +11.6% and +19.9%, respectively; both p <0.01). Compared with classification based on FRFs alone, the NRI resulting from the combination of FRFs+ICCAD+IMT mean-max was +12.1% (p <0.01). The presence of at least 1 plaque (maximum IMT >1.5 mm) performed significantly worse than composite IMTs that incorporated plaques (p <0.001). Adjusted Kaplan-Meier curves showed that individuals with a FRS = 22.6% (cohort average), and both IMTmean-max and ICCAD above the median, had a 6.5% risk to develop a CVE over 3 years versus a 3.4% risk for those with the same FRS, and both IMTmean-max and ICCAD below the median. Conclusions: A risk stratification strategy based on C-IMT and ICCAD as an adjunct to FRFs is a rational approach to prevention of cardiovascular disease.
KW - cardiovascular disease
KW - carotid artery intima-media thickness
KW - carotid diameter
KW - reclassification analyses
KW - risk prediction
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U2 - 10.1016/j.jacc.2012.06.034
DO - 10.1016/j.jacc.2012.06.034
M3 - Article
C2 - 22999719
AN - SCOPUS:84867395291
SN - 0735-1097
VL - 60
SP - 1489
EP - 1499
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 16
ER -