Mitra Sayan, Biswas Raaj Kishore, Hooijenga Petra, Cassidy Sophie, Nova Andrea, De Ciutiis Isabella, Wang Tian, Kroeger Cynthia M, Stamatakis Emmanuel, Masedunskas Andrius, De Caterina Raffaele, Cagigas Maria L, Fontana Luigi
Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia.
Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
Am J Prev Cardiol. 2025 May 19;22:101011. doi: 10.1016/j.ajpc.2025.101011. eCollection 2025 Jun.
Atherosclerotic cardiovascular disease remains the leading cause of global morbidity and mortality. Identifying early markers of subclinical atherosclerosis is critical for predicting major adverse cardiovascular events (MACE) and improving prevention strategies. Carotid intima-media thickness (cIMT) is a well-established surrogate marker of atherosclerosis, but the impact of cardiometabolic risk factor burden on cIMT and future MACE risk is not fully understood.
To assess the association between cIMT and the risk of MACE, and to evaluate the relationship between a composite cardiometabolic-risk biomarker index and cIMT as well as future MACE risk.
Prospective cohort study using data from the UK Biobank, with a median follow-up of 4.3 years.
Population-based study of 29,292 participants from the UK Biobank.
Men and women aged 40 to 69 years (n=29,292) free from cardiovascular disease at baseline. Exclusions were made for those with prior coronary heart disease, myocardial infarction, and heart failure.
Carotid intima-media thickness (cIMT) measured at baseline. A composite cardiometabolic-risk biomarker index (CRBI) was developed using HbA1c, total cholesterol ratio, and blood pressure.
The primary outcomes were the risk of MACE, including coronary heart disease (CHD), myocardial infarction (MI), and heart failure (HF). The association between cIMT, CRBI, and the risk of these events was evaluated using hazard ratios (HRs) and adjusted for confounders.
Higher cIMT values (>800 µm) were predictive of increased risk for CHD (HR: 2.15 at 800 µm; 95 % CI: 1.07-4.31) and MI (HR: 2.46 at 800 µm; 95 % CI: 0.93-6.53). The cumulative burden of cardiometabolic risk factors, as measured by the CRBI score, was significantly associated with increased cIMT (β=44.38 µm for very high CRBI score; 95 % CI: 38.25-50.51; < 0.001) and future MI risk (HR: 10.43 for very high CRBI score; 95 % CI: 3.18-34.24). Lifestyle factors such as smoking and physical activity were also correlated with higher cIMT, particularly in males.
Carotid intima-media thickness is a strong predictor of coronary heart disease and myocardial infarction. The cumulative cardiometabolic-risk biomarker index offers additional predictive value for subclinical atherosclerosis and future cardiovascular events. These findings underscore the importance of comprehensive cardiometabolic health in CVD prevention strategies.
动脉粥样硬化性心血管疾病仍然是全球发病和死亡的主要原因。识别亚临床动脉粥样硬化的早期标志物对于预测主要不良心血管事件（MACE）和改进预防策略至关重要。颈动脉内膜中层厚度（cIMT）是一种公认的动脉粥样硬化替代标志物，但心脏代谢危险因素负担对cIMT和未来MACE风险的影响尚未完全了解。
评估cIMT与MACE风险之间的关联，并评估综合心脏代谢风险生物标志物指数与cIMT以及未来MACE风险之间的关系。
前瞻性队列研究，使用英国生物银行的数据，中位随访时间为4.3年。
基于人群的研究，来自英国生物银行的29292名参与者。
年龄在40至69岁之间的男性和女性（n = 29292），基线时无心血管疾病。排除那些有既往冠心病、心肌梗死和心力衰竭的患者。
基线时测量的颈动脉内膜中层厚度（cIMT）。使用糖化血红蛋白、总胆固醇比值和血压制定了综合心脏代谢风险生物标志物指数（CRBI）。
主要结局是MACE风险，包括冠心病（CHD）、心肌梗死（MI）和心力衰竭（HF）。使用风险比（HR）评估cIMT、CRBI与这些事件风险之间的关联，并对混杂因素进行调整。
较高的cIMT值（>800 µm）可预测冠心病风险增加（800 µm时HR：2.15；95%CI：1.07 - 4.31）和心肌梗死风险增加（800 µm时HR：2.46；95%CI：0.93 - 6.53）。通过CRBI评分衡量的心脏代谢危险因素累积负担与cIMT增加（极高CRBI评分时β = 44.38 µm；95%CI：38.25 - 50.51；P < 0.001）和未来心肌梗死风险显著相关（极高CRBI评分时HR：10.43；95%CI：3.18 - 34.24）。吸烟和体育活动等生活方式因素也与较高的cIMT相关，尤其是在男性中。
颈动脉内膜中层厚度是冠心病和心肌梗死的有力预测指标。综合心脏代谢风险生物标志物指数为亚临床动脉粥样硬化和未来心血管事件提供了额外的预测价值。这些发现强调了全面心脏代谢健康在心血管疾病预防策略中的重要性。
