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Original Contribution
August 22 2012

Common Carotid Intima-Media Thickness Measurements in Cardiovascular Risk Prediction: A Meta-analysis

Author Affiliations

Author Affiliations: Julius Center for Health Sciences and Primary Care (Drs Den Ruijter, Peters, Eijkemans, Grobbee, Koffijberg, Moons, and Bots) and Department of Experimental Cardiology (Dr Den Ruijter), University Medical Center Utrecht, Utrecht, the Netherlands; Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (Dr Anderson); Department of Epidemiology and Public Health, University College London, London, United Kingdom (Dr Britton); Institute for Health and Care Research, VU Medical Center, Amsterdam, the Netherlands (Drs Dekker and Nijpels); Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden (Drs Engström, Hedblad, and Rosvall); Department of Biostatistical Sciences and Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina (Mr Evans); Department of General Internal Medicine, Division of Vascular Medicine, Nijmegen University Medical Centre, the Netherlands (Drs de Graaf and Holewijn); University of Malaya Medical Center, Kuala Lumpur, Malaysia (Dr Grobbee); Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (Drs Hofman, Kavousi, and Witteman); Osaka Medical Center for Health Science and Promotion, Osaka, Japan (Drs Ikeda and Kitamura); Stroke Center, Department of Neurology, Osaka University Graduate School of Medicine, Osaka (Drs Kitagawa and Okazaki); Department of Medicine, Division of Cardiology and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (Dr Lonn); Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany (Drs Lorenz and Sitzer); Brain and Circulation Research Group, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway (Dr Mathiesen); Department of Radiology, Tufts Medical Center, Boston, Massachusetts (Drs O’Leary and Polak); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (Drs Price and Robertson); Cardiology Division, Department of Internal Medicine, University of Virginia, Charlottesville (Dr Rembold); Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida (Dr Rundek); MAS-Metabolic Analytical Services Oy, Helsinki, Finland (Dr Salonen); Department of Neurology Klinikum Herford, Herford, Germany (Drs Sitzer); and Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands (Dr Stehouwer).

JAMA. 2012;308(8):796-803. doi:10.1001/jama.2012.9630

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.