Article

Support for the notion that a carotid intima-media thickness (CIMT) measurement
is useful in individual cardiovascular risk prediction in addition to a risk
function may come from studies showing that for an individual a high or low CIMT
measurement leads to a correct shift from one to another risk category and this
shift is followed by different treatment consequences. We set out to
systematically review the published evidence by performing a PubMed search (2
March 2009). Out of 50 publications on CIMT and future events, 31 reported on the
relation in the correct domain, [i.e. those free from symptomatic vascular
disease or diabetes mellitus in which assessment of risk using a risk function
(e.g. Framingham or SCORE) to base initiation of drug treatment upon is
recommended]. Most studies reported relative risks (or equivalents) for the
entire population only, and no information on relative risks within certain risk
categories that may be of use to reclassify individuals based on combination of
absolute and relative risks. No data on potential shifts of participants was
presented. Eight studies specifically focused on the added value of CIMT in risk
prediction. In seven studies the area under the curve (AUC) of a receiver
operating characteristic was used to assess improvements in risk prediction.
These analyses showed that addition of a CIMT measurement to established risk
factors led to small and sometimes significant improvements in the AUC. However,
change in AUC should not be the only parameter to rely on to judge the
appropriateness of CIMT in risk stratification. In one study (n = 242), evidence
was presented in participants with an intermediate Framingham risk score, a CIMT
measurement above the 60th (men) and 80th (women) percentile of age-specific
normal CIMT values, shifted participants above the threshold for initiation of
drug therapy. Yet, the study was based on 24 events, and no information was
presented on the proportion of participants correctly shifted. At present it
seems that the published evidence to quantitatively support the use of a CIMT
measurement to help in risk stratification on top of a risk function is limited.

Langue : ANGLAIS

Tiré à part : OUI