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Diabetes Care. 2015 Oct;38(10):1921-9. doi: 10.2337/dc14-2732. Epub 2015 Jul 15.

Carotid intima-media thickness progression and risk of vascular events in people with diabetes: results from the PROG-IMT collaboration.

Author information

1
Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany matthias.lorenz@em.uni-frankfurt.de.
2
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, U.K.
3
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
4
Tufts University School of Medicine, Tufts Medical Center, Boston, MA.
5
Department of Neurology, University Hospital of the Technical University of Munich, Munich, Germany.
6
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
7
Department of Internal Medicine B/Cardiology, Greifswald University Clinic, Greifswald, Germany.
8
Department of Clinical Medicine, University of Tromsø, Tromsø, Norway.
9
University of Paris Sud-XI, Paris, France.
10
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
11
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
12
Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany Department of Neurology, Klinikum Herford, Herford, Germany.
13
Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL.
14
Department of Medicine, Uppsala University, Uppsala, Sweden.
15
Department of Epidemiology, Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
16
Wallenberg Laboratory for Cardiovascular Research, University of Gothenburg, Gothenburg, Sweden.
17
SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy IRCCS MultiMedica, Milan, Italy.
18
Radiology Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
19
Department of Biostatistics, University of Washington, Seattle, WA.
20
Department of Psychiatry, University Hospital of the Technical University of Munich, Munich, Germany.
21
Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University of Greifswald, Greifswald, Germany German Centre for Cardiovascular Research, Greifswald, Germany.
22
Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Department of Neurology and Neurophysiology, University Hospital of Northern Norway, Tromsø, Norway.
23
INSERM U 970, Paris, France.
24
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K.
25
Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
26
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY École des Hautes Études en Santé Publique, Paris, France INSERM U 738, Paris, France.
27
SISA Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy.
28
Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
29
Department of Neurology, University Hospital of the Technical University of Munich, Munich, Germany Department of Neurology, Benedictus Hospital Tutzing and Feldafing, Feldafing, Germany.
30
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands Department of Epidemiology, Harvard School of Public Health, Boston, MA.
31
Department of Neurology, Greifswald University Clinic, Greifswald, Germany.
32
INSERM U 970, Paris, France Gerontology Department, Broca Hospital, Paris, France.
33
IRCCS MultiMedica, Milan, Italy Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy.
34
Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
35
MRC Biostatistics Unit, Institute of Public Health, Cambridge, U.K.
36
Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, U.K.

Abstract

OBJECTIVE:

Carotid 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 METHODS:

In 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.

RESULTS:

Average 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).

CONCLUSIONS:

Despite 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.

PMID:
26180107
PMCID:
PMC4580609
DOI:
10.2337/dc14-2732
[Indexed for MEDLINE]
Free PMC Article

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