title: Progression of carotid intima-media thickness as predictor of vascular events: results from the IMPROVE study.
abstract: OBJECTIVE
  To investigate whether several different measures of carotid intima-media thickness (IMT) progression are associated with subsequent vascular events and whether such associations are independent of baseline carotid atherosclerotic profile and Framingham risk factors.
  
  
  RESULTS
  A longitudinal cohort study (the Carotid Intima Media Thickness [IMT] and IMT-Progression as Predictors of Vascular Events in a High Risk European Population study) was performed in 7 centers in 5 European countries (Finland, France, Italy, the Netherlands, and Sweden). Three thousand four hundred eighty-two subjects (median age 64.1 years; 47.8% men) with ≥ 3 vascular risk factors were recruited and monitored for a postprogression median follow-up of 21.5 months, during which time 129 subjects experienced a first vascular event (incidence of 20.4 per 1000 person-years). The 15th month progression of mean and maximum carotid IMT of the left and right common carotids, bifurcations, internal carotid arteries, and their composite measures, as well as the fastest IMTmax progression (Fastest-IMT(max-progr)) detected in the whole carotid tree regardless of location, were used in statistical analyses. All carotid IMT measures showed significant progression during the first 15 months (P<0.001), but only the Fastest-IMT(max-progr) was significantly associated with the risk of subsequent vascular events. The Fastest-IMT(max-progr) association persisted after Bonferroni correction for multiple comparisons and after adjustments for Framingham risk factors and pharmacological treatments (all P<0.005). The use of Framingham Risk Score in place of Framingham risk factors provided almost identical results (P=0.003).
  
  
  CONCLUSIONS
  The Fastest-IMT(max-progr), a novel approach to assess carotid IMT progression, identifies focal increases of carotid IMT and, in contrast to other progression variables, is associated with cardiovascular risk.
authors.affiliation: Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano, Milan, Italy.
authors.forename: Damiano
authors.initials: D
authors.lastname: Baldassarre
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Anders
authors.initials: A
authors.lastname: Hamsten
authors.forename: Steve E
authors.initials: SE
authors.lastname: Humphries
authors.forename: Rainer
authors.initials: R
authors.lastname: Rauramaa
authors.forename: Ulf
authors.initials: U
authors.lastname: de Faire
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Smit
authors.forename: Philippe
authors.initials: P
authors.lastname: Giral
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kurl
authors.forename: Elmo
authors.initials: E
authors.lastname: Mannarino
authors.forename: Enzo
authors.initials: E
authors.lastname: Grossi
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Paoletti
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000401:mortality; D016009:Chi-Square Distribution; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology* / Q000401:mortality; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: cardiovascular diseases; carotid artery intima-media thickness; carotid ultrasound; progression; risk prediction