Published online before print January 22, 2007, doi: 10.1161/CIRCULATIONAHA.106.628875
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(Circulation. 2007;115:459-467.)
© 2007 American Heart Association, Inc.
Epidemiology |
Prediction of Clinical Cardiovascular Events With Carotid Intima-Media Thickness
A Systematic Review and Meta-Analysis
From the Department of Neurology (M.W.L., M.S.), Johann Wolfgang Goethe University, Frankfurt am Main, Germany; the St. George’s University of London (H.S.M.), London, United Kingdom; the Julius Center for Health Sciences and Primary Care (M.L.B.), University Medical Center Utrecht, Utrecht, the Netherlands; the Department of Epidemiology and Biostatistics (M.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; and the Department of Community Medicine (M.R.), Lund University, Malmo University Hospital, Malmo, Sweden.
Correspondence to Matthias W. Lorenz MD, Johann Wolfgang Goethe-University, Department for Neurology, Schleusenweg 2-16, D-60528 Frankfurt/Main, Germany. E-mail matthias.lorenz{at}em.uni-frankfurt.de
Received March 23, 2006; accepted November 29, 2006.
Background— Carotid intima-media thickness (IMT) is increasingly used as a surrogate marker for atherosclerosis. Its use relies on its ability to predict future clinical cardiovascular end points. We performed a systematic review and meta-analysis of data to examine this association.
Methods and Results— Using a prespecified search strategy, we identified 8 relevant studies and compared study design, measurement protocols, and reported data. We identified sources of heterogeneity between studies. The assumption of a linear relationship between IMT and risk was challenged by use of a graphical technique. To obtain a pooled estimate of the relative risk per IMT difference, we performed a meta-analysis based on random effects models. The age- and sex-adjusted overall estimates of the relative risk of myocardial infarction were 1.26 (95% CI, 1.21 to 1.30) per 1–standard deviation common carotid artery IMT difference and 1.15 (95% CI, 1.12 to 1.17) per 0.10-mm common carotid artery IMT difference. The age- and sex-adjusted relative risks of stroke were 1.32 (95% CI, 1.27 to 1.38) per 1–standard deviation common carotid artery IMT difference and 1.18 (95% CI, 1.16 to 1.21) per 0.10-mm common carotid artery IMT difference. Major sources of heterogeneity were age distribution, carotid segment definition, and IMT measurement protocol. The relationship between IMT and risk was nonlinear, but the linear models fitted relatively well for moderate to high IMT values.
Conclusions— Carotid IMT is a strong predictor of future vascular events. The relative risk per IMT difference is slightly higher for the end point stroke than for myocardial infarction. In future IMT studies, ultrasound protocols should be aligned with published studies. Data for younger individuals are limited and more studies are required.
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