Common Carotid Intima-Media Thickness Measurements in Cardiovascular Risk Prediction: A Meta-Analysis

Study Questions:

What is the incremental utility of common carotid intima-media thickness (CIMT) above that of the Framingham risk score in predicting 10-year risk of first-time myocardial infarction or stroke?

Methods:

The authors performed an individual patient data meta-analysis of studies that enrolled patients drawn from the general population, assessed common CIMT at baseline, and followed study subjects until the first myocardial infarction or stroke.

Results:

A total of 14 studies (n = 45,828 individuals) were pooled and the median follow-up was 11 years. There were 4,007 myocardial infarctions or strokes. There was no difference in the c-statistic of the Framingham risk score or of a model combining the Framingham risk score with common CIMT measurement in estimating the absolute 10-year risk of first-time myocardial infarction or stroke (0.757; 95% confidence interval [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% (95% CI, 2.7%-4.6%).

Conclusions:

The addition of common CIMT measurements to the Framingham risk score was associated with a statistically significant, but clinically unimportant improvement in 10-year risk prediction of first-time myocardial infarction or stroke.

Perspective:

This study again confirms the lack of any substantive utility of common CIMT measurement for assessment of risk prediction. Some recent studies suggest that measurement of internal CIMT may be superior to common CIMT, but until the clinical utility of this finding is established in larger studies, there is no clinical role for routine assessment of CIMT for risk prediction or for guiding preventive therapy.

Clinical Topics: Noninvasive Imaging, Echocardiography/Ultrasound

Keywords: Myocardial Infarction, Stroke, Follow-Up Studies, Carotid Intima-Media Thickness, Cardiology, Cardiovascular Diseases, Risk Factors, Carotid Arteries, Tunica Media


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