Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study.
BACKGROUND
The relation of a single risk factor with atherosclerosis is established. Clinically we know of risk factor clustering within individuals. Yet, studies into the magnitude of the relation of risk factor clusters with atherosclerosis are limited. Here, we assessed that relation.


METHODS
Individual participant data from 14 cohorts, involving 59,025 individuals were used in this cross-sectional analysis. We made 15 clusters of four risk factors (current smoking, overweight, elevated blood pressure, elevated total cholesterol). Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) between clusters using those without any of the four risk factors as reference group.


RESULTS
Compared to the reference, those with 1, 2, 3 or 4 risk factors had a significantly higher common CIMT: mean difference of 0.026 mm, 0.052 mm, 0.074 mm and 0.114 mm, respectively. These findings were the same in men and in women, and across ethnic groups. Within each risk factor cluster (1, 2, 3 risk factors), groups with elevated blood pressure had the largest CIMT and those with elevated cholesterol the lowest CIMT, a pattern similar for men and women.


CONCLUSIONS
Clusters of risk factors relate to increased common CIMT in a graded manner, similar in men, women and across race-ethnic groups. Some clusters seemed more atherogenic than others. Our findings support the notion that cardiovascular prevention should focus on sets of risk factors rather than individual levels alone, but may prioritize within clusters.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,Utrecht, the Netherlands.
Xin
X
Wang
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,Utrecht, the Netherlands.
Geertje W
http://orcid.org/0000-0002-9048-6635
GW
Dalmeijer
Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Hester M
HM
den Ruijter
Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada.
Todd J
TJ
Anderson
Department of Epidemiology and Public Health University College London, London, United Kingdom.
Annie R
AR
Britton
Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Jacqueline
J
Dekker
Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Gunnar
G
Engström
Department of Biostatistical Sciences and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
Greg W
GW
Evans
Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Jacqueline
J
de Graaf
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,Utrecht, the Netherlands.|University of Malaya Medical Center, Kuala Lumpur, Malaysia.
Diederick E
DE
Grobbee
Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Bo
B
Hedblad
Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Suzanne
S
Holewijn
Osaka Medical Center for Health Science and Promotion, Osaka, Japan.
Ai
A
Ikeda
The Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Jussi
J
Kauhanen
Department of Neurology, Tokyo Women Medical University, Tokyo, Japan.
Kazuo
K
Kitagawa
Osaka Medical Center for Health Science and Promotion, Osaka, Japan.
Akihiko
A
Kitamura
The Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Sudhir
S
Kurl
Department of Medicine, Division of Cardiology and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Eva M
EM
Lonn
Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany.|Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany.
Matthias W
MW
Lorenz
Brain and Circulation Research Group, Department of Clinical Medicine, University of Tromsö, Tromsö, Norway.
Ellisiv B
EB
Mathiesen
Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Giel
G
Nijpels
Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Shuhei
S
Okazaki
Department of Radiology, Tufts University School of Medicine, Boston, United States of America.
Joseph F
JF
Polak
Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
Jacqueline F
JF
Price
Cardiology Division, Department of Internal Medicine, University of Virginia, Charlottesville, VA, United States of America.
Christopher M
CM
Rembold
Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Maria
M
Rosvall
Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fl, United States of America.
Tatjana
T
Rundek
Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.|MAS-Metabolic Analytical Services Oy, Helsinki, Finland.
Jukka T
JT
Salonen
Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany and Department of Neurology Klinikum Herford, Germany.
Matthias
M
Sitzer
Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
Coen D A
CD
Stehouwer
The Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Tomi-Pekka
TP
Tuomainen
The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.
Sanne A E
SA
Peters
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,Utrecht, the Netherlands.
Michiel L
ML
Bots
D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D002784:Cholesterol / Q000097:blood; D016000:Cluster Analysis; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D050177:Overweight / Q000000981:diagnostic imaging / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology
D002784:Cholesterol