Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study

Xin Wang, Geertje W. Dalmeijer, Hester M. Den Ruijter, Todd J. Anderson, Annie R. Britton, Jacqueline Dekker, Gunnar Engström, Greg W. Evans, Jacqueline De Graaf, Diederick E. Grobbee, Bo Hedblad, Suzanne Holewijn, Ai Ikeda, Jussi Kauhanen, Kazuo Kitagawa, Akihiko Kitamura, Sudhir Kurl, Eva M. Lonn, Matthias W. Lorenz, Ellisiv B. MathiesenGiel Nijpels, Shuhei Okazaki, Joseph F. Polak, Jacqueline F. Price, Christopher M. Rembold, Maria Rosvall, Tatjana Rundek, Jukka T. Salonen, Matthias Sitzer, Coen D A Stehouwer, Tomi Pekka Tuomainen, Sanne A E Peters, Michiel L. Bots

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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. Conclusion: 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.

Original languageEnglish (US)
Article numbere0173393
JournalPLoS One
Volume12
Issue number3
DOIs
StatePublished - Mar 1 2017

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Carotid Intima-Media Thickness
Cluster Analysis
risk factors
Blood pressure
nationalities and ethnic groups
Hypercholesterolemia
atherosclerosis
Ethnic Groups
blood pressure
Linear Models
Atherosclerosis
Cholesterol
cholesterol
Blood Pressure
Linear regression
cross-sectional studies
Cross-Sectional Studies
Smoking

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Wang, X., Dalmeijer, G. W., Den Ruijter, H. M., Anderson, T. J., Britton, A. R., Dekker, J., ... Bots, M. L. (2017). Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study. PLoS One, 12(3), [e0173393]. https://doi.org/10.1371/journal.pone.0173393

Clustering of cardiovascular risk factors and carotid intima-media thickness : The USE-IMT study. / Wang, Xin; Dalmeijer, Geertje W.; Den Ruijter, Hester M.; Anderson, Todd J.; Britton, Annie R.; Dekker, Jacqueline; Engström, Gunnar; Evans, Greg W.; De Graaf, Jacqueline; Grobbee, Diederick E.; Hedblad, Bo; Holewijn, Suzanne; Ikeda, Ai; Kauhanen, Jussi; Kitagawa, Kazuo; Kitamura, Akihiko; Kurl, Sudhir; Lonn, Eva M.; Lorenz, Matthias W.; Mathiesen, Ellisiv B.; Nijpels, Giel; Okazaki, Shuhei; Polak, Joseph F.; Price, Jacqueline F.; Rembold, Christopher M.; Rosvall, Maria; Rundek, Tatjana; Salonen, Jukka T.; Sitzer, Matthias; Stehouwer, Coen D A; Tuomainen, Tomi Pekka; Peters, Sanne A E; Bots, Michiel L.

In: PLoS One, Vol. 12, No. 3, e0173393, 01.03.2017.

Research output: Contribution to journalArticle

Wang, X, Dalmeijer, GW, Den Ruijter, HM, Anderson, TJ, Britton, AR, Dekker, J, Engström, G, Evans, GW, De Graaf, J, Grobbee, DE, Hedblad, B, Holewijn, S, Ikeda, A, Kauhanen, J, Kitagawa, K, Kitamura, A, Kurl, S, Lonn, EM, Lorenz, MW, Mathiesen, EB, Nijpels, G, Okazaki, S, Polak, JF, Price, JF, Rembold, CM, Rosvall, M, Rundek, T, Salonen, JT, Sitzer, M, Stehouwer, CDA, Tuomainen, TP, Peters, SAE & Bots, ML 2017, 'Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study', PLoS One, vol. 12, no. 3, e0173393. https://doi.org/10.1371/journal.pone.0173393
Wang X, Dalmeijer GW, Den Ruijter HM, Anderson TJ, Britton AR, Dekker J et al. Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study. PLoS One. 2017 Mar 1;12(3). e0173393. https://doi.org/10.1371/journal.pone.0173393
Wang, Xin ; Dalmeijer, Geertje W. ; Den Ruijter, Hester M. ; Anderson, Todd J. ; Britton, Annie R. ; Dekker, Jacqueline ; Engström, Gunnar ; Evans, Greg W. ; De Graaf, Jacqueline ; Grobbee, Diederick E. ; Hedblad, Bo ; Holewijn, Suzanne ; Ikeda, Ai ; Kauhanen, Jussi ; Kitagawa, Kazuo ; Kitamura, Akihiko ; Kurl, Sudhir ; Lonn, Eva M. ; Lorenz, Matthias W. ; Mathiesen, Ellisiv B. ; Nijpels, Giel ; Okazaki, Shuhei ; Polak, Joseph F. ; Price, Jacqueline F. ; Rembold, Christopher M. ; Rosvall, Maria ; Rundek, Tatjana ; Salonen, Jukka T. ; Sitzer, Matthias ; Stehouwer, Coen D A ; Tuomainen, Tomi Pekka ; Peters, Sanne A E ; Bots, Michiel L. / Clustering of cardiovascular risk factors and carotid intima-media thickness : The USE-IMT study. In: PLoS One. 2017 ; Vol. 12, No. 3.
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abstract = "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. Conclusion: 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.",
author = "Xin Wang and Dalmeijer, {Geertje W.} and {Den Ruijter}, {Hester M.} and Anderson, {Todd J.} and Britton, {Annie R.} and Jacqueline Dekker and Gunnar Engstr{\"o}m and Evans, {Greg W.} and {De Graaf}, Jacqueline and Grobbee, {Diederick E.} and Bo Hedblad and Suzanne Holewijn and Ai Ikeda and Jussi Kauhanen and Kazuo Kitagawa and Akihiko Kitamura and Sudhir Kurl and Lonn, {Eva M.} and Lorenz, {Matthias W.} and Mathiesen, {Ellisiv B.} and Giel Nijpels and Shuhei Okazaki and Polak, {Joseph F.} and Price, {Jacqueline F.} and Rembold, {Christopher M.} and Maria Rosvall and Tatjana Rundek and Salonen, {Jukka T.} and Matthias Sitzer and Stehouwer, {Coen D A} and Tuomainen, {Tomi Pekka} and Peters, {Sanne A E} and Bots, {Michiel L.}",
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T1 - Clustering of cardiovascular risk factors and carotid intima-media thickness

T2 - The USE-IMT study

AU - Wang, Xin

AU - Dalmeijer, Geertje W.

AU - Den Ruijter, Hester M.

AU - Anderson, Todd J.

AU - Britton, Annie R.

AU - Dekker, Jacqueline

AU - Engström, Gunnar

AU - Evans, Greg W.

AU - De Graaf, Jacqueline

AU - Grobbee, Diederick E.

AU - Hedblad, Bo

AU - Holewijn, Suzanne

AU - Ikeda, Ai

AU - Kauhanen, Jussi

AU - Kitagawa, Kazuo

AU - Kitamura, Akihiko

AU - Kurl, Sudhir

AU - Lonn, Eva M.

AU - Lorenz, Matthias W.

AU - Mathiesen, Ellisiv B.

AU - Nijpels, Giel

AU - Okazaki, Shuhei

AU - Polak, Joseph F.

AU - Price, Jacqueline F.

AU - Rembold, Christopher M.

AU - Rosvall, Maria

AU - Rundek, Tatjana

AU - Salonen, Jukka T.

AU - Sitzer, Matthias

AU - Stehouwer, Coen D A

AU - Tuomainen, Tomi Pekka

AU - Peters, Sanne A E

AU - Bots, Michiel L.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - 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. Conclusion: 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.

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