Common carotid intima-media thickness measurements do not improve cardiovascular risk prediction in individuals with elevated blood pressure: the USE-IMT collaboration.

Pubmed ID: 24614213

Pubmed Central ID: PMC4523133

Journal: Hypertension (Dallas, Tex. : 1979)

Publication Date: June 1, 2014

Affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. hruijte2@umcutrecht.nl.

MeSH Terms: Humans, Male, Adult, Female, Aged, Cardiovascular Diseases, Risk Factors, Cohort Studies, Middle Aged, Hypertension, Risk Assessment, Blood Pressure, Carotid Artery, Common, Carotid Intima-Media Thickness, Antihypertensive Agents, Meta-Analysis as Topic

Grants: HHSN268200800007C, HHSN268201200036C, N01 HC085085, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, R01 AG023629, U01 HL080295, MR/K013351/1, PG/11/63/29011, RG/13/2/30098

Authors: Franco OH, Lorenz MW, Polak JF, Kavousi M, Mathiesen EB, Rundek T, Bots ML, Hofman A, Sitzer M, Evans GW, Grobbee DE, Rosvall M, Dekker JM, Nijpels G, Stehouwer CD, Kitamura A, den Ruijter HM, Peters SA, Groenewegen KA, Anderson TJ, Britton AR, Engström G, de Graaf J, Hedblad B, Holewijn S, Ikeda A, Kitagawa K, Ikram MA, Lonn EM, Okazaki S, O'Leary DH, Price JF, Robertson C, Rembold CM, Salonen JT

Cite As: Bots ML, Groenewegen KA, Anderson TJ, Britton AR, Dekker JM, Engström G, Evans GW, de Graaf J, Grobbee DE, Hedblad B, Hofman A, Holewijn S, Ikeda A, Kavousi M, Kitagawa K, Kitamura A, Ikram MA, Lonn EM, Lorenz MW, Mathiesen EB, Nijpels G, Okazaki S, O'Leary DH, Polak JF, Price JF, Robertson C, Rembold CM, Rosvall M, Rundek T, Salonen JT, Sitzer M, Stehouwer CD, Franco OH, Peters SA, den Ruijter HM. Common carotid intima-media thickness measurements do not improve cardiovascular risk prediction in individuals with elevated blood pressure: the USE-IMT collaboration. Hypertension 2014 Jun;63(6):1173-81. Epub 2014 Mar 10.

Studies:

Abstract

Carotid intima-media thickness (CIMT) is a marker of cardiovascular risk. It is unclear whether measurement of mean common CIMT improves 10-year risk prediction of first-time myocardial infarction or stroke in individuals with elevated blood pressure. We performed an analysis among individuals with elevated blood pressure (i.e., a systolic blood pressure ≥140 mm Hg and a diastolic blood pressure ≥ 90 mm Hg) in USE-IMT, a large ongoing individual participant data meta-analysis. We refitted the risk factors of the Framingham Risk Score on asymptomatic individuals (baseline model) and expanded this model with mean common CIMT (CIMT model) measurements. From both models, 10-year risks to develop a myocardial infarction or stroke were estimated. In individuals with elevated blood pressure, we compared discrimination and calibration of the 2 models and calculated the net reclassification improvement (NRI). We included 17 254 individuals with elevated blood pressure from 16 studies. During a median follow-up of 9.9 years, 2014 first-time myocardial infarctions or strokes occurred. The C-statistics of the baseline and CIMT models were similar (0.73). NRI with the addition of mean common CIMT was small and not significant (1.4%; 95% confidence intervals, -1.1 to 3.7). In those at intermediate risk (n=5008, 10-year absolute risk of 10% to 20%), the NRI was 5.6% (95% confidence intervals, 1.6-10.4). There is no added value of measurement of mean common CIMT in individuals with elevated blood pressure for improving cardiovascular risk prediction. For those at intermediate risk, the addition of mean common CIMT to an existing cardiovascular risk score is small but statistically significant.