• Matthias W Lorenz, Jackie F Price, Christine Robertson, Michiel L Bots, Joseph F Polak, Holger Poppert, Maryam Kavousi, Marcus Dörr, Eva Stensland, Pierre Ducimetiere, Kimmo Ronkainen, Stefan Kiechl, Matthias Sitzer, Tatjana Rundek, Lars Lind, Jing Liu, Göran Bergström, Liliana Grigore, Lena Bokemark, Alfonsa Friera, David Yanez, Horst Bickel, M Arfan Ikram, Henry Völzke, Stein Harald Johnsen, Jean Philippe Empana, Tomi-Pekka Tuomainen, Peter Willeit, Helmuth Steinmetz, Moise Desvarieux, Wuxiang Xie, Caroline Schmidt, Giuseppe D Norata, Carmen Suarez, Dirk Sander, Albert Hofman, Ulf Schminke, Ellisiv Mathiesen, Matthieu Plichart, Jussi Kauhanen, Johann Willeit, Ralph L Sacco, Stela McLachlan, Dong Zhao, Björn Fagerberg, Alberico L Catapano, Rafael Gabriel, Oscar H Franco, Alpaslan Bülbül, Frank Scheckenbach, Anja Pflug, Lu Gao, and Simon G Thompson.
• Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany matthias.lorenz@em.uni-frankfurt.de.
• Diabetes Care. 2015 Oct 1; 38 (10): 1921-9.

ObjectiveCarotid intima-media thickness (CIMT) is a marker of subclinical organ damage and predicts cardiovascular disease (CVD) events in the general population. It has also been associated with vascular risk in people with diabetes. However, the association of CIMT change in repeated examinations with subsequent CVD events is uncertain, and its use as a surrogate end point in clinical trials is controversial. We aimed at determining the relation of CIMT change to CVD events in people with diabetes.Research Design And MethodsIn a comprehensive meta-analysis of individual participant data, we collated data from 3,902 adults (age 33-92 years) with type 2 diabetes from 21 population-based cohorts. We calculated the hazard ratio (HR) per standard deviation (SD) difference in mean common carotid artery intima-media thickness (CCA-IMT) or in CCA-IMT progression, both calculated from two examinations on average 3.6 years apart, for each cohort, and combined the estimates with random-effects meta-analysis.ResultsAverage mean CCA-IMT ranged from 0.72 to 0.97 mm across cohorts in people with diabetes. The HR of CVD events was 1.22 (95% CI 1.12-1.33) per SD difference in mean CCA-IMT, after adjustment for age, sex, and cardiometabolic risk factors. Average mean CCA-IMT progression in people with diabetes ranged between -0.09 and 0.04 mm/year. The HR per SD difference in mean CCA-IMT progression was 0.99 (0.91-1.08).ConclusionsDespite reproducing the association between CIMT level and vascular risk in subjects with diabetes, we did not find an association between CIMT change and vascular risk. These results do not support the use of CIMT progression as a surrogate end point in clinical trials in people with diabetes.© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

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