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Eur J Prev Cardiol. 2016 Jul;23(11):1165-73. doi: 10.1177/2047487315625543. Epub 2016 Jan 8.

Normative values for carotid intima media thickness and its progression: Are they transferrable outside of their cohort of origin?

Author information

1
Department of Neurology, Goethe University, Frankfurt am Main, Germany.
2
Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy SISA Centre for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy.
3
Tufts University School of Medicine, Tufts Medical Center, Boston, USA.
4
Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, The Netherlands.
5
IRCSS Multimedica, Milan, Italy Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy.
6
Department of Neurology, Miller School of Medicine, University of Miami, USA.
7
Atherosclerosis Department, Cardiology Research Centre, Moscow, Russia.
8
Department of Neurology, Benedictus Hospital Tutzing & Feldafing, Feldafing, Germany Department of Neurology, Technische Universität München, Germany.
9
Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK.
10
Department of Neurology, Goethe University, Frankfurt am Main, Germany matthias.lorenz@em.uni-frankfurt.de.
11
Ultrasound Vascular Laboratory, Cardiology Research Centre2, Moscow, Russia.
12
SISA Centre for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Italy.
13
Paris Cardiovascular Research Centre (PARCC), University Paris Descartes, Sorbonne Paris Cité, France.
14
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
15
Centre for Population Health Sciences, University of Edinburgh, UK.
16
Wallenberg Laboratory for Cardiovascular Research, Institution for Medicin, Department for Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden.
17
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
18
Department of Neurology, Greifswald University Clinic, Germany.
19
Department of Medicine, Uppsala University, Sweden.
20
Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK Department of Neurology, Medical University Innsbruck, Austria.
21
Department of Biostatistics, University of Washington, Seattle, USA.
22
Department of Neurology, Technische Universität München, Germany.
23
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
24
Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands Department of Radiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
25
Department of Clinical Medicine, University of Tromsø, Norway Department of Neurology, University Hospital of Northern Norway, Tromsø, Norway.
26
Parcelsus Medical University, Salzburg, Austria Department of Geriatric Medicine, Gemeinnützige Salzburger Landeskliniken Betriebsgesellschaft GmbH Christian-Doppler-Klinik, Salzburg, Austria.
27
Radiology Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain.
28
Department of Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, China.
29
Assistance Publique, Hôpitaux de Paris, Hôpital Broca, Paris, France.
30
Center for Cardiovascular Health, Department of Epidemiology, Biochemistry, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.
31
Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, Greifswald, Germany.
32
Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
33
Department of Neurology, Medical University Innsbruck, Austria.
34
Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
35
Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain.
36
University Paris Sud Xi, Kremlin-Bicêtre, Le Kremlin-Bicêtre, France.
37
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
38
Department B for Internal Medicine, University Medicine Greifswald, Germany German Centrefor Cardiovascular Research (DZHK), partner site Greifswald, Germany.
39
Department of Epidemiology and Biostatistics, University Medical Centre, Amsterdam, The Netherlands.
40
Department of Neurology, Goethe University, Frankfurt am Main, Germany Department of Neurology, Klinikum Herford, Germany.
41
Department of Psychiatry and Psychotherapy, Technische Universität München, Germany.
42
Instituto de Investigación IdiPAZ, Hospital Universitario La Paz, Madrid, Spain.
43
Department of Medicine, Pediatrics, Biochemistry, Epidemiology, Tulane University School of Medicine and School of Public Health and Tropical Medicine, New Orleans, USA.
44
Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands.

Abstract

BACKGROUND:

The clinical use of carotid intima media thickness (cIMT) requires normal values, which may be subject to variation of geographical factors, ethnicity or measurement details. The influence of these factors has rarely been studied. The aim of this study was to determine whether normative cIMT values and their association with event risk are generalizable across populations.

DESIGN:

Meta-analysis of individual participant data.

METHOD:

From 22 general population cohorts from Europe, North America and Asia we selected subjects free of cardiovascular disease. Percentiles of cIMT and cIMT progression were assessed separately for every cohort. Cox proportional hazards models for vascular events were used to estimate hazard ratios for cIMT in each cohort. The estimates were pooled across Europe, North America and Asia, with random effects meta-analysis. The influence of geography, ethnicity and ultrasound protocols on cIMT values and on the hazard ratios was examined by meta-regression.

RESULTS:

Geographical factors, ethnicity and the ultrasound protocol had influence neither on the percentiles of cIMT and its progression, nor on the hazard ratios of cIMT for vascular events. Heterogeneity for percentiles of cIMT and cIMT progression was too large to create meaningful normative values.

CONCLUSIONS:

The distribution of cIMT values is too heterogeneous to define universal or regional population reference values. CIMT values vary widely between different studies regardless of ethnicity, geographic location and ultrasound protocol. Prediction of vascular events with cIMT values was more consistent across all cohorts, ethnicities and regions.

KEYWORDS:

Intima media thickness; cardiovascular risk; ethnicity; geographic; hazard ratio; normal value

PMID:
26746227
DOI:
10.1177/2047487315625543
[Indexed for MEDLINE]

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