Seekircher Lisa, Tschiderer Lena, Lind Lars, Safarova Maya S, Kavousi Maryam, Ikram M Arfan, Lonn Eva, Yusuf Salim, Grobbee Diederick E, Kastelein John J P, Visseren Frank L J, Walters Matthew, Dawson Jesse, Higgins Peter, Agewall Stefan, Catapano Alberico, de Groot Eric, Espeland Mark A, Klingenschmid Gerhard, Magliano Dianna, Olsen Michael H, Preiss David, Sander Dirk, Skilton Michael, Zozulińska-Ziółkiewicz Dorota A, Grooteman Muriel P C, Blankestijn Peter J, Kitagawa Kazuo, Okazaki Shuhei, Manzi Maria V, Mancusi Costantino, Izzo Raffaele, Desvarieux Moise, Rundek Tatjana, Gerstein Hertzel C, Bots Michiel L, Sweeting Michael J, Lorenz Matthias W, Willeit Peter
Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
Department of Medicine, Uppsala University, Uppsala, Sweden.
Eur Heart J Open. 2023 Sep 20;3(5):oead089. doi: 10.1093/ehjopen/oead089. eCollection 2023 Sep.
Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive values.
We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02 mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [ = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; ² = 30.7%) and 1.20 (1.18-1.23; ² = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; ² = 8.4%) and 1.14 (1.12-1.16; ²=1.3%) upon multivariable adjustment (all < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near ( < 0.001), +0.0037 for far wall ( = 0.006)].
The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls.
当前指南建议在颈总动脉（CCA）远壁测量颈动脉内膜中层厚度（IMT）。我们旨在精确量化CCA近壁与远壁IMT与动脉粥样硬化性心血管疾病（CVD，定义为冠心病或中风）风险的关联及其额外的预测价值。
我们分析了来自Proof-ATHERO联盟16项前瞻性研究的41941名参与者的个体记录{平均年龄61岁[标准差（SD）=11]；53%为女性；16%曾患CVD}。CCA近壁与远壁IMT的平均基线值分别为0.83（SD = 0.28）和0.82（SD = 0.27）mm，平均相差0.02 mm（95%一致性界限：-0.40至0.43），且呈中度相关[ = 0.44；95%置信区间（CI）：0.39 - 0.49]。在中位随访9.3年期间，我们记录了10423例CVD事件。我们使用随机效应荟萃分析汇总了特定研究的CVD风险比。CCA近壁与远壁IMT值与CVD风险大致呈线性相关。在调整年龄、性别和既往CVD后，每升高1个SD的相应风险比分别为1.18（95%CI：1.14 - 1.22；² = 30.7%）和1.20（1.18 - 1.23；² = 5.3%），多变量调整后为1.09（1.07 - 1.12；² = 8.4%）和1.14（1.12 - 1.16；² = 1.3%）（均 < 0.001）。评估双侧CCA-IMT比仅评估单侧CCA-IMT能带来更大的C指数改善[近壁为+0.0046对+0.0023（ < 0.001），远壁为+0.0037（ = 0.006）]。
CCA近壁与远壁IMT与新发CVD的关联均为正向，大致呈线性，且强度相似。双侧测量CCA-IMT时风险判别改善最大。
