@article{5da6941010384b81ae0e90bcbbd7b5b0,
title = "Common carotid intima-media thickness does not add to Framingham risk score in individuals with diabetes mellitus: The USE-IMT initiative",
abstract = "Aims/hypothesis: The aim of this work was to investigate whether measurement of the mean common carotid intima-media thickness (CIMT) improves cardiovascular risk prediction in individuals with diabetes. Methods: We performed a subanalysis among 4,220 individuals with diabetes in a large ongoing individual participant data meta-analysis involving 56,194 subjects from 17 population-based cohorts worldwide. We first refitted the risk factors of the Framingham heart risk score on the individuals without previous cardiovascular disease (baseline model) and then expanded this model with the mean common CIMT (CIMT model). The absolute 10 year risk for developing a myocardial infarction or stroke was estimated from both models. In individuals with diabetes we compared discrimination and calibration of the two models. Reclassification of individuals with diabetes was based on allocation to another cardiovascular risk category when mean common CIMT was added. Results: During a median follow-up of 8.7 years, 684 first-time cardiovascular events occurred among the population with diabetes. The C statistic was 0.67 for the Framingham model and 0.68 for the CIMT model. The absolute 10 year risk for developing a myocardial infarction or stroke was 16% in both models. There was no net reclassification improvement with the addition of mean common CIMT (1.7%; 95% CI -1.8, 3.8). There were no differences in the results between men and women. Conclusions/interpretation: There is no improvement in risk prediction in individuals with diabetes when measurement of the mean common CIMT is added to the Framingham risk score. Therefore, this measurement is not recommended for improving individual cardiovascular risk stratification in individuals with diabetes.",
keywords = "Atherosclerosis, Cardiovascular disease, Carotid intima-media thickness, Diabetes, Prognosis, Risk prediction",
author = "{Den Ruijter}, {H. M.} and Peters, {S. A.E.} and Groenewegen, {K. A.} and Anderson, {T. J.} and Britton, {A. R.} and Dekker, {J. M.} and G. Engstr{\"o}m and Eijkemans, {M. J.} and Evans, {G. W.} and {De Graaf}, J. and Grobbee, {D. E.} and B. Hedblad and A. Hofman and S. Holewijn and A. Ikeda and M. Kavousi and K. Kitagawa and A. Kitamura and H. Koffijberg and Ikram, {M. A.} and Lonn, {E. M.} and Lorenz, {M. W.} and Mathiesen, {E. B.} and G. Nijpels and S. Okazaki and O'Leary, {D. H.} and Polak, {J. F.} and Price, {J. F.} and C. Robertson and Rembold, {C. M.} and M. Rosvall and T. Rundek and Salonen, {J. T.} and M. Sitzer and Stehouwer, {C. D.A.} and Witteman, {J. C.} and Moons, {K. G.} and Bots, {M. L.}",
note = "Funding Information: Funding This project is supported by a grant from the Netherlands Organisation for Health Research and Development (ZonMw 200320003). Funding Information: Duality of interest J. de Graaf received a Dutch Heart Foundation grant to perform the NBS2 study (Nijmegen Biomedical Study). G. Engstr{\"o}m was employed by AstraZeneca as a senior epidemiologist. K. Kitagawa was employed by Osaka University Hospital, received a grant from the Ministry of Education, Culture, Sports, and Technology of Japan and received lecture fees from sanofi-aventis. E. M. Lonn was a consultant for Merck and Hoffman-La Roche, provided expert testimony for Merck, received grants from AstraZeneca, sanofi-aventis, Novartis and GlaxoSmithKline and received lecture fees from Merck and Novartis. E. B. Mathiesen received a grant from the North Norwegian Health Authorities. D. H. O{\textquoteright}Leary owns stock in Medpace. J. F. Polak received a grant from the National Heart, Lung, and Blood Institute. J. F. Price received a grant from the British Heart Foundation. T. Rundek received grants from the National Institutes of Health. J. T. Salonen received a grant from the University of Eastern Finland for the funding of the Kuopio Ischaemic Heart Disease Risk Factor study. D. E. Grobbee and M. L. Bots reported having been a consultant, for and having received grants and lecture fees from, AstraZeneca. All other authors declare that there is no duality of interest associated with this manuscript.",
year = "2013",
month = jul,
doi = "10.1007/s00125-013-2898-9",
language = "English (US)",
volume = "56",
pages = "1494--1502",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer Verlag",
number = "7",
}
