Abstract
BackgroundCarotid intima‐media thickness and carotid plaque are well‐established imaging markers used to capture different stages of the atherosclerotic disease process. We aimed to quantify to which extent carotid intima‐media thickness predicts incidence of first‐ever carotid plaque.Materials and methodsTwo independent reviewers conducted a comprehensive literature search of PubMed and Web of Science. To be eligible for inclusion, prospective studies were required to involve participants free of carotid plaque at baseline and report on the association of baseline carotid intima‐media thickness with development of first‐ever carotid plaque. Study‐specific relative risks and 95% confidence intervals were collected and pooled using random‐effects meta‐analysis.ResultsWe identified seven relevant prospective studies involving a total of 9341 participants. Individuals were recruited between 1987 and 2012, average age at baseline was 54 years, and 63% were female. Studies reported on 1288 incident first‐ever carotid plaques, occurring over an average maximum follow‐up of 8.7 years. When individuals in the top fourth of baseline carotid intima‐media thickness distribution were compared with those in the bottom fourth, the pooled relative risk for incidence of first‐ever carotid plaque was 1.78 (95% confidence interval: 1.53‐2.07, P < .001, I 2 = 2.8%). The strength of association was not modified by mean baseline age, proportion of female participants, length of follow‐up, year of baseline, and geographical location of the studies.ConclusionsIn general population studies, elevated baseline carotid intima‐media thickness is associated with incidence of carotid plaque in individuals free of carotid plaque at baseline.
Highlights
Atherosclerosis—a common cause of cardiovascular disease (CVD)—is characterised by alterations of the vessel walls, including accumulation of lipid deposits and initiation of inflammation leading to the development of arterial lesions.[1]
In order to provide an overview of current evidence and reliably quantify the relationship between elevated carotid intima-media thickness (cIMT) and development of carotid plaque, we performed a systematic literature review to identify studies that had reported on the association between baseline cIMT and incidence of firstever carotid plaque among individuals free of baseline carotid plaque and conducted a literature-based meta-analysis of individual study results
This literature-based meta-analysis of seven prospective studies involving a total of 9341 individuals identified a positive association between increased baseline cIMT and incidence of first-ever carotid plaque
Summary
Atherosclerosis—a common cause of cardiovascular disease (CVD)—is characterised by alterations of the vessel walls, including accumulation of lipid deposits and initiation of inflammation leading to the development of arterial lesions.[1]. CIMT and carotid plaque may represent distinct phenotypes of vascular remodelling.[15,16] This theory is underpinned by genetic studies that revealed distinct genes to be associated with cIMT and carotid plaque.[17,18] On the other hand, cIMT and carotid plaque are considered to represent different stages of atherogenesis characterised by continuous arterial wall growth Following this theory would imply cIMT being a predictive measure for the initiation and development of new carotid plaque and would further endorse the relevance of cIMT as a tool to quantify atherosclerosis—and identify individuals at elevated risk for future CVD—at a very early stage. In order to provide an overview of current evidence and reliably quantify the relationship between elevated cIMT and development of carotid plaque, we performed a systematic literature review to identify studies that had reported on the association between baseline cIMT and incidence of firstever carotid plaque among individuals free of baseline carotid plaque and conducted a literature-based meta-analysis of individual study results
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