Common carotid intima-media thickness measurements incardiovascular risk prediction: A meta-analysis

Hester M. Den Ruijter, Sanne A E Peters, Todd J. Anderson, Annie R. Britton, Jacqueline M. Dekker, Marinus J. Eijkemans, Gunnar Engström, Gregory W. Evans, Jacqueline De Graaf, Diederick E. Grobbee, Bo Hedblad, Albert Hofman, Suzanne Holewijn, Ai Ikeda, Maryam Kavousi, Kazuo Kitagawa, Akihiko Kitamura, Hendrik Koffijberg, Eva M. Lonn, Matthias W. LorenzEllisiv B. Mathiesen, Giel Nijpels, Shuhei Okazaki, Daniel H. O'Leary, Joseph F. Polak, Jackie F. Price, Christine Robertson, Christopher M. Rembold, Maria Rosvall, Tatjana Rundek, Jukka T. Salonen, Matthias Sitzer, Coen D A Stehouwer, Jacqueline C. Witteman, Karel G. Moons, Michiel L. Bots

Research output: Contribution to journalArticle

388 Citations (Scopus)

Abstract

Context: The evidence that measurement of the common carotid intima-media thickness (CIMT) improves the risk scores in prediction of the absolute risk of cardiovascular events is inconsistent. Objective: To determine whether common CIMT has added value in 10-year risk prediction of first-time myocardial infarctions or strokes, above that of the Framingham Risk Score. Data Sources: Relevant studies were identified through literature searches of databases (PubMed from 1950 to June 2012 and EMBASE from 1980 to June 2012) and expert opinion. Study Selection: Studies were included if participants were drawn from the general population, common CIMT was measured at baseline, and individuals were followed up for first-time myocardial infarction or stroke. Data Extraction: Individual data were combined into 1 data set and an individual participant data meta-analysis was performed on individuals without existing cardiovascular disease. Results: We included 14 population-based cohorts contributing data for 45 828 individuals. During a median follow-up of 11 years, 4007 first-time myocardial infarctions or strokes occurred. We first refitted the risk factors of the Framingham Risk Score and then extended the model with common CIMT measurements to estimate the absolute 10-year risks to develop a first-time myocardial infarction or stroke in both models. The C statistic of both models was similar (0.757; 95% CI, 0.749-0.764; and 0.759; 95% CI, 0.752-0.766). The net reclassification improvement with the addition of common CIMT was small (0.8%; 95% CI, 0.1%-1.6%). In those at intermediate risk, the net reclassification improvement was 3.6% in all individuals (95% CI, 2.7%-4.6%) and no differences between men and women. Conclusion: The addition of common CIMT measurements to the Framingham Risk Score was associated with small improvement in 10-year risk prediction of first-time myocardial infarction or stroke, but this improvement is unlikely to be of clinical importance.

Original languageEnglish
Pages (from-to)796-803
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume308
Issue number8
StatePublished - Aug 22 2012

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Carotid Intima-Media Thickness
Meta-Analysis
Stroke
Myocardial Infarction
Information Storage and Retrieval
Expert Testimony
PubMed
Population
Cardiovascular Diseases
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Den Ruijter, H. M., Peters, S. A. E., Anderson, T. J., Britton, A. R., Dekker, J. M., Eijkemans, M. J., ... Bots, M. L. (2012). Common carotid intima-media thickness measurements incardiovascular risk prediction: A meta-analysis. JAMA - Journal of the American Medical Association, 308(8), 796-803.

Common carotid intima-media thickness measurements incardiovascular risk prediction : A meta-analysis. / Den Ruijter, Hester M.; Peters, Sanne A E; Anderson, Todd J.; Britton, Annie R.; Dekker, Jacqueline M.; Eijkemans, Marinus J.; Engström, Gunnar; Evans, Gregory W.; De Graaf, Jacqueline; Grobbee, Diederick E.; Hedblad, Bo; Hofman, Albert; Holewijn, Suzanne; Ikeda, Ai; Kavousi, Maryam; Kitagawa, Kazuo; Kitamura, Akihiko; Koffijberg, Hendrik; Lonn, Eva M.; Lorenz, Matthias W.; Mathiesen, Ellisiv B.; Nijpels, Giel; Okazaki, Shuhei; O'Leary, Daniel H.; Polak, Joseph F.; Price, Jackie F.; Robertson, Christine; Rembold, Christopher M.; Rosvall, Maria; Rundek, Tatjana; Salonen, Jukka T.; Sitzer, Matthias; Stehouwer, Coen D A; Witteman, Jacqueline C.; Moons, Karel G.; Bots, Michiel L.

In: JAMA - Journal of the American Medical Association, Vol. 308, No. 8, 22.08.2012, p. 796-803.

Research output: Contribution to journalArticle

Den Ruijter, HM, Peters, SAE, Anderson, TJ, Britton, AR, Dekker, JM, Eijkemans, MJ, Engström, G, Evans, GW, De Graaf, J, Grobbee, DE, Hedblad, B, Hofman, A, Holewijn, S, Ikeda, A, Kavousi, M, Kitagawa, K, Kitamura, A, Koffijberg, H, Lonn, EM, Lorenz, MW, Mathiesen, EB, Nijpels, G, Okazaki, S, O'Leary, DH, Polak, JF, Price, JF, Robertson, C, Rembold, CM, Rosvall, M, Rundek, T, Salonen, JT, Sitzer, M, Stehouwer, CDA, Witteman, JC, Moons, KG & Bots, ML 2012, 'Common carotid intima-media thickness measurements incardiovascular risk prediction: A meta-analysis', JAMA - Journal of the American Medical Association, vol. 308, no. 8, pp. 796-803.
Den Ruijter HM, Peters SAE, Anderson TJ, Britton AR, Dekker JM, Eijkemans MJ et al. Common carotid intima-media thickness measurements incardiovascular risk prediction: A meta-analysis. JAMA - Journal of the American Medical Association. 2012 Aug 22;308(8):796-803.
Den Ruijter, Hester M. ; Peters, Sanne A E ; Anderson, Todd J. ; Britton, Annie R. ; Dekker, Jacqueline M. ; Eijkemans, Marinus J. ; Engström, Gunnar ; Evans, Gregory W. ; De Graaf, Jacqueline ; Grobbee, Diederick E. ; Hedblad, Bo ; Hofman, Albert ; Holewijn, Suzanne ; Ikeda, Ai ; Kavousi, Maryam ; Kitagawa, Kazuo ; Kitamura, Akihiko ; Koffijberg, Hendrik ; Lonn, Eva M. ; Lorenz, Matthias W. ; Mathiesen, Ellisiv B. ; Nijpels, Giel ; Okazaki, Shuhei ; O'Leary, Daniel H. ; Polak, Joseph F. ; Price, Jackie F. ; Robertson, Christine ; Rembold, Christopher M. ; Rosvall, Maria ; Rundek, Tatjana ; Salonen, Jukka T. ; Sitzer, Matthias ; Stehouwer, Coen D A ; Witteman, Jacqueline C. ; Moons, Karel G. ; Bots, Michiel L. / Common carotid intima-media thickness measurements incardiovascular risk prediction : A meta-analysis. In: JAMA - Journal of the American Medical Association. 2012 ; Vol. 308, No. 8. pp. 796-803.
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abstract = "Context: The evidence that measurement of the common carotid intima-media thickness (CIMT) improves the risk scores in prediction of the absolute risk of cardiovascular events is inconsistent. Objective: To determine whether common CIMT has added value in 10-year risk prediction of first-time myocardial infarctions or strokes, above that of the Framingham Risk Score. Data Sources: Relevant studies were identified through literature searches of databases (PubMed from 1950 to June 2012 and EMBASE from 1980 to June 2012) and expert opinion. Study Selection: Studies were included if participants were drawn from the general population, common CIMT was measured at baseline, and individuals were followed up for first-time myocardial infarction or stroke. Data Extraction: Individual data were combined into 1 data set and an individual participant data meta-analysis was performed on individuals without existing cardiovascular disease. Results: We included 14 population-based cohorts contributing data for 45 828 individuals. During a median follow-up of 11 years, 4007 first-time myocardial infarctions or strokes occurred. We first refitted the risk factors of the Framingham Risk Score and then extended the model with common CIMT measurements to estimate the absolute 10-year risks to develop a first-time myocardial infarction or stroke in both models. The C statistic of both models was similar (0.757; 95{\%} CI, 0.749-0.764; and 0.759; 95{\%} CI, 0.752-0.766). The net reclassification improvement with the addition of common CIMT was small (0.8{\%}; 95{\%} CI, 0.1{\%}-1.6{\%}). In those at intermediate risk, the net reclassification improvement was 3.6{\%} in all individuals (95{\%} CI, 2.7{\%}-4.6{\%}) and no differences between men and women. Conclusion: The addition of common CIMT measurements to the Framingham Risk Score was associated with small improvement in 10-year risk prediction of first-time myocardial infarction or stroke, but this improvement is unlikely to be of clinical importance.",
author = "{Den Ruijter}, {Hester M.} and Peters, {Sanne A E} and Anderson, {Todd J.} and Britton, {Annie R.} and Dekker, {Jacqueline M.} and Eijkemans, {Marinus J.} and Gunnar Engstr{\"o}m and Evans, {Gregory W.} and {De Graaf}, Jacqueline and Grobbee, {Diederick E.} and Bo Hedblad and Albert Hofman and Suzanne Holewijn and Ai Ikeda and Maryam Kavousi and Kazuo Kitagawa and Akihiko Kitamura and Hendrik Koffijberg and Lonn, {Eva M.} and Lorenz, {Matthias W.} and Mathiesen, {Ellisiv B.} and Giel Nijpels and Shuhei Okazaki and O'Leary, {Daniel H.} and Polak, {Joseph F.} and Price, {Jackie F.} and Christine Robertson and Rembold, {Christopher M.} and Maria Rosvall and Tatjana Rundek and Salonen, {Jukka T.} and Matthias Sitzer and Stehouwer, {Coen D A} and Witteman, {Jacqueline C.} and Moons, {Karel G.} and Bots, {Michiel L.}",
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TY - JOUR

T1 - Common carotid intima-media thickness measurements incardiovascular risk prediction

T2 - A meta-analysis

AU - Den Ruijter, Hester M.

AU - Peters, Sanne A E

AU - Anderson, Todd J.

AU - Britton, Annie R.

AU - Dekker, Jacqueline M.

AU - Eijkemans, Marinus J.

AU - Engström, Gunnar

AU - Evans, Gregory W.

AU - De Graaf, Jacqueline

AU - Grobbee, Diederick E.

AU - Hedblad, Bo

AU - Hofman, Albert

AU - Holewijn, Suzanne

AU - Ikeda, Ai

AU - Kavousi, Maryam

AU - Kitagawa, Kazuo

AU - Kitamura, Akihiko

AU - Koffijberg, Hendrik

AU - Lonn, Eva M.

AU - Lorenz, Matthias W.

AU - Mathiesen, Ellisiv B.

AU - Nijpels, Giel

AU - Okazaki, Shuhei

AU - O'Leary, Daniel H.

AU - Polak, Joseph F.

AU - Price, Jackie F.

AU - Robertson, Christine

AU - Rembold, Christopher M.

AU - Rosvall, Maria

AU - Rundek, Tatjana

AU - Salonen, Jukka T.

AU - Sitzer, Matthias

AU - Stehouwer, Coen D A

AU - Witteman, Jacqueline C.

AU - Moons, Karel G.

AU - Bots, Michiel L.

PY - 2012/8/22

Y1 - 2012/8/22

N2 - Context: The evidence that measurement of the common carotid intima-media thickness (CIMT) improves the risk scores in prediction of the absolute risk of cardiovascular events is inconsistent. Objective: To determine whether common CIMT has added value in 10-year risk prediction of first-time myocardial infarctions or strokes, above that of the Framingham Risk Score. Data Sources: Relevant studies were identified through literature searches of databases (PubMed from 1950 to June 2012 and EMBASE from 1980 to June 2012) and expert opinion. Study Selection: Studies were included if participants were drawn from the general population, common CIMT was measured at baseline, and individuals were followed up for first-time myocardial infarction or stroke. Data Extraction: Individual data were combined into 1 data set and an individual participant data meta-analysis was performed on individuals without existing cardiovascular disease. Results: We included 14 population-based cohorts contributing data for 45 828 individuals. During a median follow-up of 11 years, 4007 first-time myocardial infarctions or strokes occurred. We first refitted the risk factors of the Framingham Risk Score and then extended the model with common CIMT measurements to estimate the absolute 10-year risks to develop a first-time myocardial infarction or stroke in both models. The C statistic of both models was similar (0.757; 95% CI, 0.749-0.764; and 0.759; 95% CI, 0.752-0.766). The net reclassification improvement with the addition of common CIMT was small (0.8%; 95% CI, 0.1%-1.6%). In those at intermediate risk, the net reclassification improvement was 3.6% in all individuals (95% CI, 2.7%-4.6%) and no differences between men and women. Conclusion: The addition of common CIMT measurements to the Framingham Risk Score was associated with small improvement in 10-year risk prediction of first-time myocardial infarction or stroke, but this improvement is unlikely to be of clinical importance.

AB - Context: The evidence that measurement of the common carotid intima-media thickness (CIMT) improves the risk scores in prediction of the absolute risk of cardiovascular events is inconsistent. Objective: To determine whether common CIMT has added value in 10-year risk prediction of first-time myocardial infarctions or strokes, above that of the Framingham Risk Score. Data Sources: Relevant studies were identified through literature searches of databases (PubMed from 1950 to June 2012 and EMBASE from 1980 to June 2012) and expert opinion. Study Selection: Studies were included if participants were drawn from the general population, common CIMT was measured at baseline, and individuals were followed up for first-time myocardial infarction or stroke. Data Extraction: Individual data were combined into 1 data set and an individual participant data meta-analysis was performed on individuals without existing cardiovascular disease. Results: We included 14 population-based cohorts contributing data for 45 828 individuals. During a median follow-up of 11 years, 4007 first-time myocardial infarctions or strokes occurred. We first refitted the risk factors of the Framingham Risk Score and then extended the model with common CIMT measurements to estimate the absolute 10-year risks to develop a first-time myocardial infarction or stroke in both models. The C statistic of both models was similar (0.757; 95% CI, 0.749-0.764; and 0.759; 95% CI, 0.752-0.766). The net reclassification improvement with the addition of common CIMT was small (0.8%; 95% CI, 0.1%-1.6%). In those at intermediate risk, the net reclassification improvement was 3.6% in all individuals (95% CI, 2.7%-4.6%) and no differences between men and women. Conclusion: The addition of common CIMT measurements to the Framingham Risk Score was associated with small improvement in 10-year risk prediction of first-time myocardial infarction or stroke, but this improvement is unlikely to be of clinical importance.

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