From the Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Centre (Servizio di Epidemiologia e Farmacologia Preventiva), University of Milan, Italy (E.O., A.B., M.C., E.T., A.L.C.).
Società Italiana per lo Studio dell'Aterosclerosi Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Milan, Italy (A.B., L.G., F.P., A.P.).
Stroke. 2019 Jul;50(7):1758-1765. doi: 10.1161/STROKEAHA.118.024692. Epub 2019 Jun 5.
Background and Purpose- The value of carotid intima-media thickness (cIMT)-a marker of subclinical atherosclerosis-in defining the cardiovascular risk is still debated. The aim of this study was to estimate standard cIMT progression, adjusting values over time for the main cardiovascular risk factors, in a sample of low-to-moderate cardiovascular risk subjects, to identify normative cIMT progression values. Methods- From the progression of lesions in the intima of the carotid cohort, we selected subjects who underwent 4 planned serial clinical evaluations and ultrasound cIMT determinations, on average every 4 years. Subject taking glucose-lowering therapies in secondary cardiovascular prevention or with cardiovascular risk score >5 were excluded from the analysis. The growth of cIMT across the study period (12 years) was assessed by use of individual growth curve modeling within multilevel models. Results- A total of 1175 (36% men; mean age, 53±11 years at baseline) participants at low/intermediate cardiovascular risk have been included in this analysis. A significant and marked slope of the mean and maximum cIMT growth curves (β=0.009 and β=0.012, respectively) was observed, confirming that it is a function of age. A stratified analysis by decades of age highlighted a nonlinear cIMT progression over time. In addition, different patterns of cIMT development between sex were observed. Finally, different slopes in mean and maximum cIMT curves, with a significant spread since the fifth decade, were observed in the cIMT growth curve models of subjects developing multifocal carotid atherosclerosis compared with the rest of the population. Conclusions- These findings proved that the rate of change in cIMT over time is a sign of the development of atherosclerosis, which cannot be a priori assumed linear. These data, therefore, support the clinical relevance of these growth curve models for cIMT progression to be considered as useful tool to identify subjects with faster atherosclerosis progression and thus at increased cardiovascular risk.
背景与目的- 颈动脉内膜中层厚度（cIMT）——一种亚临床动脉粥样硬化的标志物——在定义心血管风险方面的价值仍存在争议。本研究的目的是在低至中度心血管风险人群中，估计标准 cIMT 进展，调整随时间变化的主要心血管风险因素，以确定正常 cIMT 进展值。方法- 从颈动脉病变进展队列中，我们选择了接受 4 次计划的连续临床评估和超声 cIMT 测定的患者，平均每 4 年一次。在二次心血管预防中服用降糖药物或心血管风险评分>5 的患者被排除在分析之外。在多水平模型中使用个体生长曲线模型评估 cIMT 在整个研究期间（12 年）的增长情况。结果- 共有 1175 名（36%为男性；基线时平均年龄为 53±11 岁）低/中度心血管风险患者纳入本分析。观察到平均和最大 cIMT 生长曲线的斜率显著且明显（β=0.009 和 β=0.012，分别），这证实了它是年龄的函数。按年龄十年分层分析显示，cIMT 随时间呈非线性进展。此外，观察到了不同性别之间的 cIMT 发展模式。最后，与其余人群相比，在多灶性颈动脉粥样硬化患者的 cIMT 生长曲线模型中，观察到了平均和最大 cIMT 曲线的斜率不同，并且自第五十年开始有明显的差异。结论- 这些发现证明了 cIMT 随时间的变化率是动脉粥样硬化发展的标志，不能先验地假设为线性。因此，这些数据支持这些生长曲线模型在 cIMT 进展方面的临床相关性，将其视为识别具有更快动脉粥样硬化进展和更高心血管风险的患者的有用工具。
