Is carotid intima media thickness useful for individual prediction of cardiovascular risk? Ten-year results from the Carotid Atherosclerosis Progression Study (CAPS).
Level 3 - non-randomized controlled study
Prospective cohort study evaluating prognostic performance and risk reclassification
PubMed 20530503 · doi:10.1093/eurheartj/ehq189
What was done
Researchers evaluated 4,904 subjects without pre-existing vascular disease from the Carotid Atherosclerosis Progression Study (CAPS) over 10 years of follow-up for cardiovascular events and total mortality. Using Cox models and reclassification statistics (net reclassification improvement and integrated discrimination improvement), they tested whether adding carotid intima-media thickness (cIMT) improved individual risk prediction beyond traditional Framingham and SCORE models across 10-year risk strata of 0-5%, 5-10%, 10-20%, and >=20%.
What was found
cIMT was significantly and independently predictive for cardiovascular events. Adding common cIMT to the Framingham model led to the reclassification of 357 subjects (8.1%), but this reclassification was correct in only 107 subjects (30.0%). Net reclassification improvement was -1.41% (P = NS) and integrated discrimination improvement was 0.04% (P = NS), with more subjects shifted to lower rather than higher risk categories. Analyses using other endpoint definitions, other carotid segments, and the SCORE model also failed to consistently improve risk prediction.
Why it matters
Despite its independent association with cardiovascular endpoints, cIMT measurement does not add clinically useful discriminative or reclassification value beyond standard risk scores in the general population.
Limits
The abstract does not provide exact effect estimates (hazard ratios, confidence intervals) or precise P-values. Baseline demographic characteristics, setting, and potential changes in medical therapy during the 10-year follow-up are not detailed in the abstract.
Cited by
- partial The CAFE and CAPS studies demonstrated that CIMT (carotid intima-media thickness) predicts the risk of heart attack and stroke through soft plaque.