• Hester M Den Ruijter, Sanne A E Peters, Todd J Anderson, Annie R Britton, Jacqueline M Dekker, Marinus J Eijkemans, Gunnar Engström, Gregory W Evans, Jacqueline de Graaf, Diederick E Grobbee, Bo Hedblad, Albert Hofman, Suzanne Holewijn, Ai Ikeda, Maryam Kavousi, Kazuo Kitagawa, Akihiko Kitamura, Hendrik Koffijberg, Eva M Lonn, Matthias W Lorenz, Ellisiv B Mathiesen, Giel Nijpels, Shuhei Okazaki, Daniel H O'Leary, Joseph F Polak, Jackie F Price, Christine Robertson, Christopher M Rembold, Maria Rosvall, Tatjana Rundek, Jukka T Salonen, Matthias Sitzer, Coen D A Stehouwer, Jacqueline C Witteman, Karel G Moons, and Michiel L Bots.
• Julius Center for Health Sciences and Primary Care, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. hruijte2@umcutrecht.nl
• JAMA. 2012 Aug 22; 308 (8): 796803796-803.

ContextThe evidence that measurement of the common carotid intima-media thickness (CIMT) improves the risk scores in prediction of the absolute risk of cardiovascular events is inconsistent.ObjectiveTo determine whether common CIMT has added value in 10-year risk prediction of first-time myocardial infarctions or strokes, above that of the Framingham Risk Score.Data SourcesRelevant studies were identified through literature searches of databases (PubMed from 1950 to June 2012 and EMBASE from 1980 to June 2012) and expert opinion.Study SelectionStudies were included if participants were drawn from the general population, common CIMT was measured at baseline, and individuals were followed up for first-time myocardial infarction or stroke.Data ExtractionIndividual data were combined into 1 data set and an individual participant data meta-analysis was performed on individuals without existing cardiovascular disease.ResultsWe included 14 population-based cohorts contributing data for 45,828 individuals. During a median follow-up of 11 years, 4007 first-time myocardial infarctions or strokes occurred. We first refitted the risk factors of the Framingham Risk Score and then extended the model with common CIMT measurements to estimate the absolute 10-year risks to develop a first-time myocardial infarction or stroke in both models. The C statistic of both models was similar (0.757; 95% CI, 0.749-0.764; and 0.759; 95% CI, 0.752-0.766). The net reclassification improvement with the addition of common CIMT was small (0.8%; 95% CI, 0.1%-1.6%). In those at intermediate risk, the net reclassification improvement was 3.6% in all individuals (95% CI, 2.7%-4.6%) and no differences between men and women.ConclusionThe addition of common CIMT measurements to the Framingham Risk Score was associated with small improvement in 10-year risk prediction of first-time myocardial infarction or stroke, but this improvement is unlikely to be of clinical importance.

11 keywords...

hide…