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Is carotid intima-media thickness useful in cardiovascular disease risk assessment? The Rotterdam Study
A I del Sol1, K G Moons, M Hollander
1Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
Adding common carotid intima-media thickness (IMT) to established risk factors offers a modest improvement in predicting coronary heart disease and cerebrovascular disease. However, IMT alone does not substantially enhance predictive value for screening purposes.
Area of Science:
- Cardiovascular epidemiology
- Medical imaging
- Risk prediction modeling
Background:
- Established risk factors for coronary heart disease (CHD) and cerebrovascular disease (CVD) include age, sex, medical history, and lifestyle factors.
- Common carotid intima-media thickness (IMT) is a marker of subclinical atherosclerosis.
Purpose of the Study:
- To determine the added predictive value of common carotid intima-media thickness (IMT) for future coronary heart disease and cerebrovascular disease.
- To assess IMT's contribution when incorporated with existing risk factors.
Main Methods:
- A nested case-control study within the Rotterdam Study, including 374 cases (stroke or myocardial infarction) and 1496 controls, aged 55+.
- Logistic regression and receiver operating characteristic (ROC) analysis were used to evaluate predictive models.
- Follow-up averaged 4.2 years to identify incident cardiovascular events.
Main Results:
- A model with age and sex had an ROC area of 0.65.
- Established risk factors improved the ROC area to 0.72, predicting 17% of events.
- Adding common carotid IMT increased the ROC area to 0.75, with IMT alone yielding an ROC area of 0.71.
Conclusions:
- While common carotid IMT shows some predictive value, its addition to established risk factors does not substantially increase the predictive capability for screening purposes.
- IMT measurement alone has moderate predictive value for cardiovascular events.
Background And Purpose:
We determined the contribution of common carotid intima-media thickness (IMT) in the prediction of future coronary heart disease and cerebrovascular disease when added to established risk factors.
Methods:
We used data from a nested case-control study comprising 374 subjects with either an incident stroke or a myocardial infarction and 1496 controls. All subjects were aged 55 years and older and participated in the Rotterdam Study. Mean follow-up was 4.2 years (range, 0.1 to 6.5 years). We evaluated which correlates of coronary heart disease and cerebrovascular disease contribute to the prediction of either a new incident myocardial infarction or a stroke. Logistic regression modeling and the area under the receiver operating characteristic curve (ROC area) were used to quantify the predictive value of the established risk factors and the added value of IMT.
Results:
The ROC area of a model with age and sex only was 0.65 (95% CI, 0.62 to 0.69). Independent risk factors were previous myocardial infarction and stroke, diabetes mellitus, smoking, systolic blood pressure, diastolic blood pressure, and total and HDL cholesterol levels. These risk factors increased the ROC area from 0.65 to 0.72 (95% CI, 0.69 to 0.75). This model correctly predicted 17% of all subjects with coronary heart disease and cerebrovascular disease. When common carotid IMT was added to the previous model, the ROC area increased to 0.75 (95% CI, 0.72 to 0.78). When only the IMT measurement was used, the ROC area was 0.71 (95% CI, 0.68 to 0.74), and 14% of all subjects were correctly predicted. There was no difference in ROC area when different measurement sites were used.
Conclusions:
Adding IMT to a risk function for coronary heart disease and cerebrovascular disease does not result in a substantial increase in the predictive value when used as a screening tool.