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Carotid Intima Media Thickness as a Predictor of CVD Risk
Quick Takes
- Carotid intima-media thickness (cIMT) is a predictor of CVD risk.
- Independent of type of intervention, reductions in cIMT are associated with reductions in CVD risk.
- The greater the reduction in cIMT progress, the greater the reduction in CVD risk.
Study Questions:
What is the association between interventions that reduce carotid intima-media thickness (cIMT) progression and cardiovascular disease (CVD) risk?
Methods:
The authors systematically collected data from randomized controlled trials. The primary outcome was a combined CVD endpoint of myocardial infarction, stroke, revascularization procedures, or fatal CVD. The authors estimated the association between reduction in cIMT progression by any type of intervention and incident CVD for each trial, then combined using a Bayesian meta-regression approach.
Results:
The authors identified 119 randomized controlled trials consisting of 100,667 patients. Included patients had a mean age of 62 years, 42% of whom were female. For each 10 μm/year reduction in cIMT progression, patients experienced a reduced risk of future CVD events (relative risk [RR], 0.91; 95% confidence interval [CI], 0.87-0.94) on top of a reduction in CVD risk relative to the intervention but not the cIMT progression reduction (RR, 0.92; 95% CI, 0.87-0.97). Estimated CVD RR ranged from 0.84 (95% CI, 0.75-0.93) for 10 μm/year reduction to 0.63 (95% CI, 0.52-0.74) for 40 μm/year reduction.
Conclusions:
The authors concluded that interventions aimed at reducing cIMT progression significantly reduce subsequent CVD risk.
Perspective:
Given that medical interventions often take years to reduce CVD events, surrogate/intermediate outcomes that reliably predict CVD risk are important for helping to power clinical trials. They also can be important risk markers for patients aiming to assess the impact of their individual treatments. Measurements of cIMT have been associated with CVD events due to their association with vascular endothelial cholesterol collection. This analysis suggests that across a range of different interventions (e.g., antihypertensives, lipid-lowering, diet), there is a consistent dose-response to the overall reduction in CVD event risk based on the degree of reduction in cIMT progression. While this study does not demonstrate a role for routine measurement of cIMT in everyday clinical practice, it does help to justify using cIMT as an important outcome measure for future CVD trials.
Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Cardiac Surgery and Arrhythmias, Interventions and Imaging, Echocardiography/Ultrasound
Keywords: Biomarkers, Cardiology Interventions, Cardiovascular Diseases, Carotid Intima-Media Thickness, Dyslipidemias, Metabolic Syndrome, Myocardial Infarction, Myocardial Revascularization, Primary Prevention, Risk Factors, Stroke, Vascular Diseases
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