title: Common carotid intima-media thickness measurements do not improve cardiovascular risk prediction in individuals with elevated blood pressure: the USE-IMT collaboration.
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.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. hruijte2@umcutrecht.nl.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Karlijn A
authors.initials: KA
authors.lastname: Groenewegen
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Anderson
authors.forename: Annie R
authors.initials: AR
authors.lastname: Britton
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Dekker
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.forename: Greg W
authors.initials: GW
authors.lastname: Evans
authors.forename: Jacqueline
authors.initials: J
authors.lastname: de Graaf
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Suzanne
authors.initials: S
authors.lastname: Holewijn
authors.forename: Ai
authors.initials: A
authors.lastname: Ikeda
authors.forename: Maryam
authors.initials: M
authors.lastname: Kavousi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kitagawa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kitamura
authors.forename: M Arfan
authors.initials: MA
authors.lastname: Ikram
authors.forename: Eva M
authors.initials: EM
authors.lastname: Lonn
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Lorenz
authors.forename: Ellisiv B
authors.initials: EB
authors.lastname: Mathiesen
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.forename: Shuhei
authors.initials: S
authors.lastname: Okazaki
authors.forename: Daniel H
authors.initials: DH
authors.lastname: O'Leary
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: Jacqueline F
authors.initials: JF
authors.lastname: Price
authors.forename: Christine
authors.initials: C
authors.lastname: Robertson
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Rembold
authors.forename: Maria
authors.initials: M
authors.lastname: Rosvall
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Jukka T
authors.initials: JT
authors.lastname: Salonen
authors.forename: Matthias
authors.initials: M
authors.lastname: Sitzer
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.forename: Sanne A E
authors.initials: SA
authors.lastname: Peters
authors.forename: Hester M
authors.initials: HM
authors.lastname: den Ruijter
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000503:physiopathology*; D017536:Carotid Artery, Common / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents
keywords: atherosclerosis; carotid intima-media thickness; primary prevention; prognosis; risk