Varying Definitions of Carotid Intima-Media Thickness and Future Cardiovascular Disease: A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational prospective cohort studies
PubMed 38014663 · doi:10.1161/JAHA.123.031217
What was done
Authors conducted a systematic review and random-effects meta-analysis of prospective cohort studies examining associations between various carotid intima-media thickness (cIMT) definitions and future cardiovascular disease (CVD) outcomes. Evaluated definitions included common carotid artery IMT (CCA-IMT), internal carotid artery IMT (ICA-IMT), combined segments (combined-IMT), mean CCA-IMT, and maximum CCA-IMT. From 2287 screened articles, 18 articles representing 14 studies with more than 10 different cIMT definitions were included.
What was found
After adjusting for age and sex, a 1-SD increase in CCA-IMT was associated with stroke (HR 1.32, 95% CI 1.27-1.38), myocardial infarction (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 associated with 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 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 showed a stronger association with MI than mean CCA-IMT, while both measures showed similar associations with stroke and CVD events.
Why it matters
Cardiovascular risk prediction varies depending on the carotid segment measured and calculation method used, with combined-segment measurements providing the strongest association with overall cardiovascular disease. These findings highlight the need for standardized cIMT imaging and measurement protocols.
Limits
Total participant sample size is not reported in the abstract. Reported associations are adjusted only for age and sex rather than comprehensive cardiovascular risk factors. Studies exhibited methodological heterogeneity, spanning more than 10 distinct cIMT definition protocols.
Cited by
- supports Carotid intima-media thickness (IMT) measured by ultrasound is an indicator of whole-body cardiovascular status.