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Multicenter Study
. 2017 Aug:263:412-419.
doi: 10.1016/j.atherosclerosis.2017.05.023. Epub 2017 May 19.

Carotid plaque-thickness and common carotid IMT show additive value in cardiovascular risk prediction and reclassification

Mauro Amato  1 , Fabrizio Veglia  1 , Ulf de Faire  2 , Philippe Giral  3 , Rainer Rauramaa  4 , Andries J Smit  5 , Sudhir Kurl  6 , Alessio Ravani  1 , Beatrice Frigerio  1 , Daniela Sansaro  1 , Alice Bonomi  1 , Calogero C Tedesco  1 , Samuela Castelnuovo  7 , Elmo Mannarino  8 , Steve E Humphries  9 , Anders Hamsten  10 , Elena Tremoli  11 , Damiano Baldassarre  12 ; IMPROVE study group
Affiliations
Multicenter Study

Carotid plaque-thickness and common carotid IMT show additive value in cardiovascular risk prediction and reclassification

Mauro Amato et al. Atherosclerosis. 2017 Aug.

Abstract

Background and aims: Carotid plaque size and the mean common carotid intima-media thickness measured in plaque-free areas (PF CC-IMTmean) have been identified as predictors of vascular events (VEs), but their complementarity in risk prediction and stratification is still unresolved. The aim of this study was to evaluate the independence of carotid plaque thickness and PF CC-IMTmean in cardiovascular risk prediction and risk stratification.

Methods: The IMPROVE-study is a European cohort (n = 3703), where the thickness of the largest plaque detected in the whole carotid tree was indexed as cIMTmax. PF CC-IMTmean was also assessed. Hazard Ratios (HR) comparing the top quartiles of cIMTmax and PF CC-IMTmeanversus their respective 1-3 quartiles were calculated using Cox regression.

Results: After a 36.2-month follow-up, there were 215 VEs (125 coronary, 73 cerebral and 17 peripheral). Both cIMTmax and PF CC-IMTmean were mutually independent predictors of combined-VEs, after adjustment for center, age, sex, risk factors and pharmacological treatment [HR (95% CI) = 1.98 (1.47, 2.67) and 1.68 (1.23, 2.29), respectively]. Both variables were independent predictors of cerebrovascular events (ischemic stroke, transient ischemic attack), while only cIMTmax was an independent predictor of coronary events (myocardial infarction, sudden cardiac death, angina pectoris, angioplasty, coronary bypass grafting). In reclassification analyses, PF CC-IMTmean significantly adds to a model including both Framingham Risk Factors and cIMTmax (Integrated Discrimination Improvement; IDI = 0.009; p = 0.0001) and vice-versa (IDI = 0.02; p < 0.0001).

Conclusions: cIMTmax and PF CC-IMTmean are independent predictors of VEs, and as such, they should be used as additive rather than alternative variables in models for cardiovascular risk prediction and reclassification.

Keywords: Atherosclerosis; Cardiovascular clinical research; Cardiovascular risk factors; Carotid intima-media thickness; Coronary artery disease; Prevention.

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Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Framingham risk factors-adjusted Kaplan-Meier incidence curves. The study population was stratified according to cIMTmax and PF-CC-IMTmean values above or below their respective 75th percentiles (2.5 and 0.76 mm), respectively. Curves were computed for the mean value of each covariate used in Table 1, Model-3 (i.e. center, age, sex, Framingham risk factors, family history of diabetes, family history of hypertension, pack-years and pharmacological treatments (statins, beta-blockers, ACE-inhibitors, diuretics and calcium-antagonists)). IMT, intima-media thickness; PF CC-IMTmean, mean common carotid IMT measured in plaque-free areas; cIMTmax, measure of the thickest plaque detected in the whole carotid tree.
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References

    1. Naqvi T.Z., Lee M.S. Carotid intima-media thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging. 2014;7:1025–1038. - PubMed
    1. Touboul P.J., Hennerici M.G., Meairs S. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). an update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany. Cerebrovasc. Dis. 2011;2012(34):290–296. - PMC - PubMed
    1. Bots M.L., Evans G.W., Tegeler C.H., Meijer R. Carotid intima-media thickness measurements: relations with atherosclerosis, risk of cardiovascular disease and application in randomized controlled trials. Chin. Med. J. Engl. 2016;129:215–226. - PMC - PubMed
    1. Johnsen S.H., Mathiesen E.B. Carotid plaque compared with intima-media thickness as a predictor of coronary and cerebrovascular disease. Curr. Cardiol. Rep. 2009;11:21–27. - PubMed
    1. Plichart M., Celermajer D.S., Zureik M. Carotid intima-media thickness in plaque-free site, carotid plaques and coronary heart disease risk prediction in older adults. the three-city study. Atherosclerosis. 2011;219:917–924. - PubMed

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