Common carotid intima-media thickness measurements do not improve cardiovascular risk prediction in individuals with elevated blood pressure: The USE-IMT collaboration

Michiel L. Bots, Karlijn A. Groenewegen, Todd J. Anderson, Annie R. Britton, Jacqueline M. Dekker, Gunnar Engström, Greg W. Evans, Jacqueline De Graaf, Diederick E. Grobbee, Bo Hedblad, Albert Hofman, Suzanne Holewijn, Ai Ikeda, Maryam Kavousi, Kazuo Kitagawa, Akihiko Kitamura, M. Arfan Ikram, Eva M. Lonn, Matthias W. Lorenz, Ellisiv B. MathiesenGiel Nijpels, Shuhei Okazaki, Daniel H. O'Leary, Joseph F. Polak, Jacqueline F. Price, Christine Robertson, Christopher M. Rembold, Maria Rosvall, Tatjana Rundek, Jukka T. Salonen, Matthias Sitzer, Coen D.A. Stehouwer, Oscar H. Franco, Sanne A.E. Peters, Hester M. Den Ruijter

Research output: Contribution to journalArticle

45 Scopus citations

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 (ie, 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.

Original languageEnglish (US)
Pages (from-to)1173-1181
Number of pages9
JournalHypertension
Volume63
Issue number6
DOIs
StatePublished - Jun 2014

Keywords

  • Atherosclerosis
  • Carotid intima-media thickness
  • Primary prevention
  • Prognosis
  • Risk

ASJC Scopus subject areas

  • Internal Medicine

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    Bots, M. L., Groenewegen, K. A., Anderson, T. J., Britton, A. R., Dekker, J. M., Engström, G., Evans, G. W., De Graaf, J., Grobbee, D. E., Hedblad, B., Hofman, A., Holewijn, S., Ikeda, A., Kavousi, M., Kitagawa, K., Kitamura, A., Ikram, M. A., Lonn, E. M., Lorenz, M. W., ... Den Ruijter, H. M. (2014). Common carotid intima-media thickness measurements do not improve cardiovascular risk prediction in individuals with elevated blood pressure: The USE-IMT collaboration. Hypertension, 63(6), 1173-1181. https://doi.org/10.1161/HYPERTENSIONAHA.113.02683