Department of Neurology, University Hospital, J W Goethe-University, Frankfurt am Main, Germany.
Lancet. 2012 Jun 2;379(9831):2053-62. doi: 10.1016/S0140-6736(12)60441-3. Epub 2012 Apr 27.
Carotid intima-media thickness (cIMT) is related to the risk of cardiovascular events in the general population. An association between changes in cIMT and cardiovascular risk is frequently assumed but has rarely been reported. Our aim was to test this association.
We identified general population studies that assessed cIMT at least twice and followed up participants for myocardial infarction, stroke, or death. The study teams collaborated in an individual participant data meta-analysis. Excluding individuals with previous myocardial infarction or stroke, we assessed the association between cIMT progression and the risk of cardiovascular events (myocardial infarction, stroke, vascular death, or a combination of these) for each study with Cox regression. The log hazard ratios (HRs) per SD difference were pooled by random effects meta-analysis.
Of 21 eligible studies, 16 with 36,984 participants were included. During a mean follow-up of 7·0 years, 1519 myocardial infarctions, 1339 strokes, and 2028 combined endpoints (myocardial infarction, stroke, vascular death) occurred. Yearly cIMT progression was derived from two ultrasound visits 2-7 years (median 4 years) apart. For mean common carotid artery intima-media thickness progression, the overall HR of the combined endpoint was 0·97 (95% CI 0·94-1·00) when adjusted for age, sex, and mean common carotid artery intima-media thickness, and 0·98 (0·95-1·01) when also adjusted for vascular risk factors. Although we detected no associations with cIMT progression in sensitivity analyses, the mean cIMT of the two ultrasound scans was positively and robustly associated with cardiovascular risk (HR for the combined endpoint 1·16, 95% CI 1·10-1·22, adjusted for age, sex, mean common carotid artery intima-media thickness progression, and vascular risk factors). In three studies including 3439 participants who had four ultrasound scans, cIMT progression did not correlate between occassions (reproducibility correlations between r=-0·06 and r=-0·02).
The association between cIMT progression assessed from two ultrasound scans and cardiovascular risk in the general population remains unproven. No conclusion can be derived for the use of cIMT progression as a surrogate in clinical trials.
Deutsche Forschungsgemeinschaft.
颈动脉内膜-中层厚度（cIMT）与普通人群心血管事件的风险相关。cIMT 变化与心血管风险之间的关联经常被假设，但很少有报道。我们的目的是检验这种关联。
我们确定了至少两次评估 cIMT 并随访参与者心肌梗死、卒中和死亡的普通人群研究。研究团队在个体参与者数据荟萃分析中合作。排除有先前心肌梗死或卒中的个体后，我们使用 Cox 回归评估了 cIMT 进展与心血管事件（心肌梗死、卒中和血管死亡或这些的组合）风险之间的关联，每个研究都进行了评估。通过随机效应荟萃分析汇总了每标准差差异的对数危险比（HR）。
在 21 项符合条件的研究中，有 16 项研究纳入了 36984 名参与者。在平均 7.0 年的随访期间，发生了 1519 例心肌梗死、1339 例卒中和 2028 例联合终点（心肌梗死、卒中和血管死亡）。每年的 cIMT 进展来自两次超声检查，两次检查相隔 2-7 年（中位 4 年）。对于颈总动脉内膜-中层厚度的平均进展，在调整年龄、性别和颈总动脉内膜-中层厚度后，联合终点的总体 HR 为 0.97（95%CI 0.94-1.00），在进一步调整血管危险因素后，HR 为 0.98（0.95-1.01）。尽管我们在敏感性分析中未发现与 cIMT 进展相关的关联，但两次超声扫描的平均 cIMT 与心血管风险呈正相关且稳健相关（联合终点的 HR 为 1.16，95%CI 1.10-1.22，调整年龄、性别、颈总动脉内膜-中层厚度进展和血管危险因素）。在包括 3439 名参与者的三项研究中，这些参与者接受了四次超声扫描，在不同时间点之间 cIMT 进展没有相关性（相关性 r 值在-0.06 和-0.02 之间）。
从两次超声扫描评估的 cIMT 进展与普通人群心血管风险之间的关联仍然没有得到证实。不能得出 cIMT 进展作为临床试验替代终点的结论。
德国研究基金会。
