Institute of Health Economics Medical University of Innsbruck Innsbruck Austria.
Department of Advanced Biomedical Sciences Federico II University Naples Italy.
J Am Heart Assoc. 2023 Jun 20;12(12):e027657. doi: 10.1161/JAHA.122.027657. Epub 2023 Jun 10.
Background The association between common carotid artery intima-media thickness (CCA-IMT) and incident carotid plaque has not been characterized fully. We therefore aimed to precisely quantify the relationship between CCA-IMT and carotid plaque development. Methods and Results We undertook an individual participant data meta-analysis of 20 prospective studies from the Proof-ATHERO (Prospective Studies of Atherosclerosis) consortium that recorded baseline CCA-IMT and incident carotid plaque involving 21 494 individuals without a history of cardiovascular disease and without preexisting carotid plaque at baseline. Mean baseline age was 56 years (SD, 9 years), 55% were women, and mean baseline CCA-IMT was 0.71 mm (SD, 0.17 mm). Over a median follow-up of 5.9 years (5th-95th percentile, 1.9-19.0 years), 8278 individuals developed first-ever carotid plaque. We combined study-specific odds ratios (ORs) for incident carotid plaque using random-effects meta-analysis. Baseline CCA-IMT was approximately log-linearly associated with the odds of developing carotid plaque. The age-, sex-, and trial arm-adjusted OR for carotid plaque per SD higher baseline CCA-IMT was 1.40 (95% CI, 1.31-1.50; =63.9%). The corresponding OR that was further adjusted for ethnicity, smoking, diabetes, body mass index, systolic blood pressure, low- and high-density lipoprotein cholesterol, and lipid-lowering and antihypertensive medication was 1.34 (95% CI, 1.24-1.45; =59.4%; 14 studies; 16 297 participants; 6381 incident plaques). We observed no significant effect modification across clinically relevant subgroups. Sensitivity analysis restricted to studies defining plaque as focal thickening yielded a comparable OR (1.38 [95% CI, 1.29-1.47]; =57.1%; 14 studies; 17 352 participants; 6991 incident plaques). Conclusions Our large-scale individual participant data meta-analysis demonstrated that CCA-IMT is associated with the long-term risk of developing first-ever carotid plaque, independent of traditional cardiovascular risk factors.
颈总动脉内膜中层厚度（CCA-IMT）与颈动脉斑块的发生之间的关联尚未得到充分描述。因此，我们旨在准确量化 CCA-IMT 与颈动脉斑块发展之间的关系。
我们对来自 Proof-ATHERO（动脉粥样硬化前瞻性研究）联盟的 20 项前瞻性研究进行了个体参与者数据荟萃分析，这些研究记录了基线 CCA-IMT 和颈动脉斑块的发生情况，涉及 21494 名无心血管疾病病史且基线时无颈动脉斑块的个体。平均基线年龄为 56 岁（标准差 9 岁），55%为女性，平均基线 CCA-IMT 为 0.71mm（标准差 0.17mm）。在中位随访 5.9 年（第 5 百分位数至第 95 百分位数为 1.9 至 19.0 年）期间，8278 人首次发生颈动脉斑块。我们使用随机效应荟萃分析合并了研究特异性颈动脉斑块发生的比值比（OR）。基线 CCA-IMT 与颈动脉斑块发生的可能性呈近似对数线性相关。与基线 CCA-IMT 每增加一个标准差相关的颈动脉斑块发生的年龄、性别和试验臂调整后 OR 为 1.40（95%置信区间 1.31-1.50；=63.9%）。进一步调整种族、吸烟、糖尿病、体重指数、收缩压、低和高密度脂蛋白胆固醇以及降脂和降压药物的相应 OR 为 1.34（95%置信区间 1.24-1.45；=59.4%；14 项研究；16297 名参与者；6381 个斑块事件）。我们在临床相关亚组中未观察到明显的效应修饰。仅限于将斑块定义为局灶性增厚的敏感性分析得出了可比的 OR（1.38[95%置信区间 1.29-1.47]；=57.1%；14 项研究；17352 名参与者；6991 个斑块事件）。
我们的大规模个体参与者数据荟萃分析表明，CCA-IMT 与首次发生颈动脉斑块的长期风险相关，独立于传统心血管危险因素。
