ABSTRACT
Title
Carotid diameter improves the carotid IMT capacity to predict coronary events: data from the IMPROVE study
Authors
M. Amato1, F. Veglia1, E. Tremoli,1,2 A. Ravani1, D. Sansaro1, C. Tedesco1, F. Bovis1, B. Frigerio2, S. Castelnuovo2 and D. Baldassarre,1,2 on behalf of the IMPROVE study group.
1Centro Cardiologico Monzino, IRCCS, Milan-Italy; 2Dept of Pharmacological Sciences, University of Milan, Milan-Italy.
1Centro Cardiologico Monzino, IRCCS, Milan-Italy; 2Dept of Pharmacological Sciences, University of Milan, Milan-Italy.
Abstract
Introduction: The “IMPROVE study” is a prospective, longitudinal study designed to investigate whether cross-sectional carotid artery intima media thickness (C-IMT) and C-IMT progression are predictors of vascular events in European individuals at high risk of cardiovascular diseases. Objective of the present study was to investigate whether C-IMT could be combined with inter-adventitial common carotid artery diameter (ICCAD) to improve the current capacity to predict vascular events over and above that provided by Framingham risk factors (FRFs).
Methods: 3711 subjects (median age 64.4 years; 48% men) with at least three vascular risk factors (VRFs) were recruited in 7 centers of 5 European countries (Finland, France, Italy, the Netherlands and Sweden). 3703 patients (median age 64.4 years, 48% men) were monitored for a median follow up of 36.2 months. During this period, 215 patients suffered a first cardiovascular event with an incidence of 19.9 per 1000 person-years.
Results: By Cox proportional hazard regression analysis, all measures of C-IMT and ICCAD were independently associated with risk of any vascular event; associations persisted after adjustment for age, gender, traditional risk factors and pharmacological treatments (Ptrend<0.005 for all). Results were mostly significant also when cardio, cerebro and peripheral vascular events were considered separately. Composite C-IMTs (IMTmean and IMTmean-max) as well as combinations of C-IMT variables and ICCAD yielded stronger relations than common carotid IMT alone. Compared to classification based on FRFs alone, the net reclassification improvement resulting from the combination of FRFs + ICCAD + IMTmean and that of FRFs + ICCAD + IMTmean-max were +11.4% and +12.1%, respectively.
Conclusions: C-IMTs and ICCAD are independent predictors of vascular events in European high-risk subjects and together they significantly enhance the predictive capacity of VRFs.
Methods: 3711 subjects (median age 64.4 years; 48% men) with at least three vascular risk factors (VRFs) were recruited in 7 centers of 5 European countries (Finland, France, Italy, the Netherlands and Sweden). 3703 patients (median age 64.4 years, 48% men) were monitored for a median follow up of 36.2 months. During this period, 215 patients suffered a first cardiovascular event with an incidence of 19.9 per 1000 person-years.
Results: By Cox proportional hazard regression analysis, all measures of C-IMT and ICCAD were independently associated with risk of any vascular event; associations persisted after adjustment for age, gender, traditional risk factors and pharmacological treatments (Ptrend<0.005 for all). Results were mostly significant also when cardio, cerebro and peripheral vascular events were considered separately. Composite C-IMTs (IMTmean and IMTmean-max) as well as combinations of C-IMT variables and ICCAD yielded stronger relations than common carotid IMT alone. Compared to classification based on FRFs alone, the net reclassification improvement resulting from the combination of FRFs + ICCAD + IMTmean and that of FRFs + ICCAD + IMTmean-max were +11.4% and +12.1%, respectively.
Conclusions: C-IMTs and ICCAD are independent predictors of vascular events in European high-risk subjects and together they significantly enhance the predictive capacity of VRFs.