Carotid intima–media thickness: a suitable alternative for cardiovascular risk as outcome?
Sanne A E Peters1, Diederick E Grobbee, Michiel L Bots
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands. s.a.e.peters@umcutrecht.nl
Insights
Carotid intima-media thickness (CIMT) progression is a valid surrogate marker for cardiovascular disease endpoints. Further research is needed to fully understand the association between CIMT changes and future cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Medical Biomarkers
- Atherosclerosis Research
Background:
- Surrogate markers are valuable for cardiovascular disease research and clinical practice.
- Carotid intima-media thickness (CIMT) is a widely used marker for atherosclerotic disease.
- A suitable surrogate marker must meet specific validation criteria.
Purpose of the Study:
- To evaluate the validity of CIMT as a surrogate marker for cardiovascular disease.
- To assess whether CIMT progression meets established criteria for surrogate endpoints.
Main Methods:
- Literature review of studies meeting predefined criteria for surrogate markers.
- Assessment of CIMT against criteria including reproducibility, risk factor association, and predictive value.
- Analysis of existing data on CIMT changes in relation to risk and interventions.
Main Results:
- Extensive evidence supports CIMT's validity as a measure of atherosclerotic disease across diverse populations.
- CIMT exhibits reproducibility and cross-sectional associations with risk factors and prevalent disease.
- Data on the relationship between changes in CIMT and changes in future risk is limited.
Conclusions:
- CIMT progression fulfills the criteria for a valid surrogate marker for cardiovascular disease endpoints.
- CIMT can be considered a reliable alternative outcome measure for cardiovascular events.
- Further investigation is warranted to explore the link between CIMT changes and future event risk.
Background:
Surrogate markers for cardiovascular disease might be of great value in observational research, clinical trials, and clinical practice. Carotid intima-media thickness (CIMT) is probably the most commonly used marker for atherosclerotic disease as an alternative for cardiovascular morbidity and mortality. A suitable marker for atherosclerosis, however, should meet several criteria before it can be validly used.
Methods And Results:
We reviewed the literature following a set of criteria for a surrogate marker. These include a comparison with a 'gold standard'; adequate reproducibility; cross-sectional relations with established risk factors and prevalent disease; relations with severity of atherosclerosis elsewhere in the arterial system; relations with the occurrence with future events; ability for a biomarker to change over time; ability to be affected by interventions over time; and relations between change over time in biomarker level and change in risk. A large number of studies from a variety of populations provide evidence for the validity of CIMT as a suitable measure of atherosclerotic disease. Data on the relation between change in CIMT and change in risk, however, is much sparser.
Conclusion:
CIMT progression meets the criteria of a surrogate for cardiovascular disease endpoints and may be considered as a valid alternative for cardiovascular events as outcome. Further studies should examine the association between changes in CIMT and changes in risk for future events.
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