Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors

L. Engelen, I. Ferreira, C.D.A. Stehouwer, O.H. Franco, D.E. Grobbee, Y.T. van der Schouw, J.W.R. Twisk, J.J.A. Dekker, E.J.M. Feskens

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117 Citations (Scopus)

Abstract

Common carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures. Methods and results We combined CCIMT data obtained by echotracking on 24 871 individuals (53% men; age range 15–101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n ¼ 4234) used to establish sex-specific equations for percentiles of CCIMT across age.With these equations, we generated CCIMT Z-scores in different reference subpopulations, thereby allowing for a standardized comparison between observed and predicted (‘normal’) values from individuals of the same age and sex. In the sub-population without CVD and treatment (n ¼ 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized bs 0.19 (95% CI: 0.16–0.22) and 0.18 (0.15–0.21)], smoking [0.25 (0.19–0.31) and 0.11 (0.04–0.18)], diabetes [0.19 (0.05–0.33) and 0.19 (0.02–0.36)], total-to-HDL cholesterol ratio [0.07 (0.04–0.10) and 0.05 (0.02–0.09)], and body mass index [0.14 (0.12–0.17) and 0.07 (0.04–0.10)]. Conclusion We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CVRFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings.
Original languageEnglish
Pages (from-to)2368-2380
JournalEuropean Heart Journal
Volume34
Issue number30
DOIs
Publication statusPublished - 2013

Fingerprint

Carotid Intima-Media Thickness
Common Carotid Artery
Cardiovascular Diseases
Reference Values
Population
Blood Pressure
Research
HDL Cholesterol
Atherosclerosis
Biomarkers
Smoking
Lipids

Keywords

  • coronary-heart-disease
  • cardiovascular-disease
  • atherosclerosis risk
  • prospective cohort
  • vascular-disease
  • sex-differences
  • task-force
  • metaanalysis
  • artery
  • ultrasound

Cite this

Engelen, L. ; Ferreira, I. ; Stehouwer, C.D.A. ; Franco, O.H. ; Grobbee, D.E. ; van der Schouw, Y.T. ; Twisk, J.W.R. ; Dekker, J.J.A. ; Feskens, E.J.M. / Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors. In: European Heart Journal. 2013 ; Vol. 34, No. 30. pp. 2368-2380.
@article{6398d57886344a84a0a2e760ee2baca9,
title = "Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors",
abstract = "Common carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures. Methods and results We combined CCIMT data obtained by echotracking on 24 871 individuals (53{\%} men; age range 15–101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n ¼ 4234) used to establish sex-specific equations for percentiles of CCIMT across age.With these equations, we generated CCIMT Z-scores in different reference subpopulations, thereby allowing for a standardized comparison between observed and predicted (‘normal’) values from individuals of the same age and sex. In the sub-population without CVD and treatment (n ¼ 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized bs 0.19 (95{\%} CI: 0.16–0.22) and 0.18 (0.15–0.21)], smoking [0.25 (0.19–0.31) and 0.11 (0.04–0.18)], diabetes [0.19 (0.05–0.33) and 0.19 (0.02–0.36)], total-to-HDL cholesterol ratio [0.07 (0.04–0.10) and 0.05 (0.02–0.09)], and body mass index [0.14 (0.12–0.17) and 0.07 (0.04–0.10)]. Conclusion We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CVRFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings.",
keywords = "coronary-heart-disease, cardiovascular-disease, atherosclerosis risk, prospective cohort, vascular-disease, sex-differences, task-force, metaanalysis, artery, ultrasound",
author = "L. Engelen and I. Ferreira and C.D.A. Stehouwer and O.H. Franco and D.E. Grobbee and {van der Schouw}, Y.T. and J.W.R. Twisk and J.J.A. Dekker and E.J.M. Feskens",
year = "2013",
doi = "10.1093/eurheartj/ehs380",
language = "English",
volume = "34",
pages = "2368--2380",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "30",

}

Engelen, L, Ferreira, I, Stehouwer, CDA, Franco, OH, Grobbee, DE, van der Schouw, YT, Twisk, JWR, Dekker, JJA & Feskens, EJM 2013, 'Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors' European Heart Journal, vol. 34, no. 30, pp. 2368-2380. https://doi.org/10.1093/eurheartj/ehs380

Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors. / Engelen, L.; Ferreira, I.; Stehouwer, C.D.A.; Franco, O.H.; Grobbee, D.E.; van der Schouw, Y.T.; Twisk, J.W.R.; Dekker, J.J.A.; Feskens, E.J.M.

In: European Heart Journal, Vol. 34, No. 30, 2013, p. 2368-2380.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Reference intervals for common carotid intima-media thickness measured with echotracking: relation with risk factors

AU - Engelen, L.

AU - Ferreira, I.

AU - Stehouwer, C.D.A.

AU - Franco, O.H.

AU - Grobbee, D.E.

AU - van der Schouw, Y.T.

AU - Twisk, J.W.R.

AU - Dekker, J.J.A.

AU - Feskens, E.J.M.

PY - 2013

Y1 - 2013

N2 - Common carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures. Methods and results We combined CCIMT data obtained by echotracking on 24 871 individuals (53% men; age range 15–101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n ¼ 4234) used to establish sex-specific equations for percentiles of CCIMT across age.With these equations, we generated CCIMT Z-scores in different reference subpopulations, thereby allowing for a standardized comparison between observed and predicted (‘normal’) values from individuals of the same age and sex. In the sub-population without CVD and treatment (n ¼ 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized bs 0.19 (95% CI: 0.16–0.22) and 0.18 (0.15–0.21)], smoking [0.25 (0.19–0.31) and 0.11 (0.04–0.18)], diabetes [0.19 (0.05–0.33) and 0.19 (0.02–0.36)], total-to-HDL cholesterol ratio [0.07 (0.04–0.10) and 0.05 (0.02–0.09)], and body mass index [0.14 (0.12–0.17) and 0.07 (0.04–0.10)]. Conclusion We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CVRFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings.

AB - Common carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures. Methods and results We combined CCIMT data obtained by echotracking on 24 871 individuals (53% men; age range 15–101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n ¼ 4234) used to establish sex-specific equations for percentiles of CCIMT across age.With these equations, we generated CCIMT Z-scores in different reference subpopulations, thereby allowing for a standardized comparison between observed and predicted (‘normal’) values from individuals of the same age and sex. In the sub-population without CVD and treatment (n ¼ 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized bs 0.19 (95% CI: 0.16–0.22) and 0.18 (0.15–0.21)], smoking [0.25 (0.19–0.31) and 0.11 (0.04–0.18)], diabetes [0.19 (0.05–0.33) and 0.19 (0.02–0.36)], total-to-HDL cholesterol ratio [0.07 (0.04–0.10) and 0.05 (0.02–0.09)], and body mass index [0.14 (0.12–0.17) and 0.07 (0.04–0.10)]. Conclusion We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CVRFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings.

KW - coronary-heart-disease

KW - cardiovascular-disease

KW - atherosclerosis risk

KW - prospective cohort

KW - vascular-disease

KW - sex-differences

KW - task-force

KW - metaanalysis

KW - artery

KW - ultrasound

U2 - 10.1093/eurheartj/ehs380

DO - 10.1093/eurheartj/ehs380

M3 - Article

VL - 34

SP - 2368

EP - 2380

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 30

ER -