Department of Epidemiology Fudan University Shanghai China.
Department of Epidemiology University of Pittsburgh Pittsburgh PA USA.
J Am Heart Assoc. 2023 Dec 5;12(23):e031217. doi: 10.1161/JAHA.123.031217. Epub 2023 Nov 28.
Carotid intima-media thickness (cIMT) has been widely used as a predictor of future cardiovascular disease (CVD); however, various definitions of cIMT exist. This study provides a systematic review and meta-analysis of the associations between different cIMT definitions and CVD.
A systematic review of the different cIMT definitions used in prospective cohort studies was performed. The relationships between cIMT of different definitions (common carotid artery IMT [CCA-IMT], internal carotid artery IMT [ICA-IMT], combined segments [combined-IMT], mean CCA-IMT, and maximum CCA-IMT) with future stroke, myocardial infarction (MI), and CVD events were analyzed using random effects models. Among 2287 articles, 18 articles (14 studies) with >10 different cIMT definitions were identified and included in our meta-analysis. After adjusting for age and sex, a 1-SD increase in CCA-IMT was associated with future stroke (hazard ratio [HR], 1.32 [95% CI, 1.27-1.38]), MI (HR, 1.27 [95% CI, 1.22-1.33]), and CVD events (HR, 1.28 [95% CI, 1.19-1.37]). A 1-SD increase in ICA-IMT was related to future stroke (HR, 1.25 [95% CI, 1.11-1.42]) and CVD events (HR, 1.25 [95% CI, 1.04-1.50]) but not MI (HR, 1.26 [95% CI, 0.98-1.61]). A 1-SD increase in combined-IMT was associated with future stroke (HR, 1.30 [95% CI, 1.08-1.57]) and CVD events (HR, 1.36 [95% CI, 1.23-1.49]). Maximum CCA-IMT was more strongly related than mean CCA-IMT with risk of MI, and both measures were similarly associated with stroke and CVD events.
Combined-IMT is more strongly associated with CVD events compared with single-segment cIMT definitions. Maximum CCA-IMT shows a stronger association with MI than mean CCA-IMT. Further research is warranted to validate our findings and to standardize the cIMT measurement protocol, as well as to explore underlying mechanisms.
颈动脉内膜中层厚度（cIMT）已被广泛用作未来心血管疾病（CVD）的预测指标；然而，cIMT 有多种定义。本研究对不同 cIMT 定义与 CVD 之间的关系进行了系统回顾和荟萃分析。
对前瞻性队列研究中使用的不同 cIMT 定义进行了系统回顾。使用随机效应模型分析了不同定义的 cIMT（颈总动脉内膜中层厚度[CCA-IMT]、颈内动脉内膜中层厚度[ICA-IMT]、综合节段[综合-IMT]、平均 CCA-IMT 和最大 CCA-IMT）与未来卒中、心肌梗死（MI）和 CVD 事件之间的关系。在 2287 篇文章中，确定了 18 篇（14 项研究）有超过 10 种不同的 cIMT 定义的文章，并纳入了我们的荟萃分析。在校正年龄和性别后，CCA-IMT 每增加 1 个标准差，与未来卒中（危险比[HR]，1.32[95%CI，1.27-1.38]）、MI（HR，1.27[95%CI，1.22-1.33]）和 CVD 事件（HR，1.28[95%CI，1.19-1.37]）相关。ICA-IMT 每增加 1 个标准差与未来卒中（HR，1.25[95%CI，1.11-1.42]）和 CVD 事件（HR，1.25[95%CI，1.04-1.50]）相关，但与 MI 无关（HR，1.26[95%CI，0.98-1.61]）。综合-IMT 每增加 1 个标准差与未来卒中（HR，1.30[95%CI，1.08-1.57]）和 CVD 事件（HR，1.36[95%CI，1.23-1.49]）相关。最大 CCA-IMT 与 MI 的风险相关性强于平均 CCA-IMT，且与卒中和 CVD 事件的相关性相似。
与单一节段 cIMT 定义相比，综合-IMT 与 CVD 事件的相关性更强。最大 CCA-IMT 与 MI 的相关性强于平均 CCA-IMT。需要进一步的研究来验证我们的发现，并标准化 cIMT 测量方案，以及探索潜在的机制。
