Department of Neurology, Goethe University, Frankfurt am Main, Germany.
MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, United Kingdom.
PLoS One. 2018 Apr 12;13(4):e0191172. doi: 10.1371/journal.pone.0191172. eCollection 2018.
Carotid intima media thickness (CIMT) predicts cardiovascular (CVD) events, but the predictive value of CIMT change is debated. We assessed the relation between CIMT change and events in individuals at high cardiovascular risk.
From 31 cohorts with two CIMT scans (total n = 89070) on average 3.6 years apart and clinical follow-up, subcohorts were drawn: (A) individuals with at least 3 cardiovascular risk factors without previous CVD events, (B) individuals with carotid plaques without previous CVD events, and (C) individuals with previous CVD events. Cox regression models were fit to estimate the hazard ratio (HR) of the combined endpoint (myocardial infarction, stroke or vascular death) per standard deviation (SD) of CIMT change, adjusted for CVD risk factors. These HRs were pooled across studies. In groups A, B and C we observed 3483, 2845 and 1165 endpoint events, respectively. Average common CIMT was 0.79mm (SD 0.16mm), and annual common CIMT change was 0.01mm (SD 0.07mm), both in group A. The pooled HR per SD of annual common CIMT change (0.02 to 0.43mm) was 0.99 (95% confidence interval: 0.95-1.02) in group A, 0.98 (0.93-1.04) in group B, and 0.95 (0.89-1.04) in group C. The HR per SD of common CIMT (average of the first and the second CIMT scan, 0.09 to 0.75mm) was 1.15 (1.07-1.23) in group A, 1.13 (1.05-1.22) in group B, and 1.12 (1.05-1.20) in group C.
We confirm that common CIMT is associated with future CVD events in individuals at high risk. CIMT change does not relate to future event risk in high-risk individuals.
颈动脉内膜中层厚度（CIMT）可预测心血管（CVD）事件，但 CIMT 变化的预测价值存在争议。我们评估了在心血管高危个体中 CIMT 变化与事件之间的关系。
从 31 个队列中，抽取了在两次 CIMT 扫描（平均间隔 3.6 年）和临床随访中具有至少 3 个心血管危险因素且无先前 CVD 事件的个体（A 亚组）、具有颈动脉斑块且无先前 CVD 事件的个体（B 亚组）和具有先前 CVD 事件的个体（C 亚组）。使用 Cox 回归模型，根据 CVD 危险因素，估算每个 CIMT 变化标准差（SD）的复合终点（心肌梗死、卒中和血管死亡）的危险比（HR）。在研究间进行 HR 汇总。在 A、B 和 C 组中，我们分别观察到 3483、2845 和 1165 个终点事件。平均共同 CIMT 为 0.79mm（SD 0.16mm），A 组的共同 CIMT 年变化率为 0.01mm（SD 0.07mm）。每年共同 CIMT 变化率（0.02 至 0.43mm）的 SD 每标准偏差 HR 分别为 0.99（95%置信区间：0.95-1.02）在 A 组，0.98（0.93-1.04）在 B 组，0.95（0.89-1.04）在 C 组。共同 CIMT 的 SD 每标准偏差 HR（第一次和第二次 CIMT 扫描的平均值，0.09 至 0.75mm）在 A 组中为 1.15（1.07-1.23），在 B 组中为 1.13（1.05-1.22），在 C 组中为 1.12（1.05-1.20）。
我们证实，在高危个体中，共同 CIMT 与未来 CVD 事件相关。CIMT 变化与高危个体的未来事件风险无关。
