Willeit, P;
Tschiderer, L;
Allara, E;
Reuber, K;
Seekircher, L;
Gao, L;
Liao, X;
... Lorenz, MW; + view all
(2020)
Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients.
Circulation
, 142
(7)
pp. 621-642.
10.1161/CIRCULATIONAHA.120.046361.
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Abstract
Background: To quantify the association between effects of interventions on carotid intima-media thickness (cIMT) progression and their effects on cardiovascular disease (CVD) risk. Methods: We systematically collated data from randomized, controlled trials. cIMT was assessed as the mean value at the common-carotid-artery; if unavailable, the maximum value at the common-carotid-artery or other cIMT measures were used. The primary outcome was a combined CVD end point defined as myocardial infarction, stroke, revascularization procedures, or fatal CVD. We estimated intervention effects on cIMT progression and incident CVD for each trial, before relating the 2 using a Bayesian meta-regression approach. Results: We analyzed data of 119 randomized, controlled trials involving 100 667 patients (mean age 62 years, 42% female). Over an average follow-up of 3.7 years, 12 038 patients developed the combined CVD end point. Across all interventions, each 10 μm/y reduction of cIMT progression resulted in a relative risk for CVD of 0.91 (95% Credible Interval, 0.87–0.94), with an additional relative risk for CVD of 0.92 (0.87–0.97) being achieved independent of cIMT progression. Taken together, we estimated that interventions reducing cIMT progression by 10, 20, 30, or 40 μm/y would yield relative risks of 0.84 (0.75–0.93), 0.76 (0.67–0.85), 0.69 (0.59–0.79), or 0.63 (0.52–0.74), respectively. Results were similar when grouping trials by type of intervention, time of conduct, time to ultrasound follow-up, availability of individual-participant data, primary versus secondary prevention trials, type of cIMT measurement, and proportion of female patients. Conclusions: The extent of intervention effects on cIMT progression predicted the degree of CVD risk reduction. This provides a missing link supporting the usefulness of cIMT progression as a surrogate marker for CVD risk in clinical trials.
| Type: | Article |
|---|---|
| Title: | Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1161/CIRCULATIONAHA.120.046361 |
| Publisher version: | http://dx.doi.org/10.1161/CIRCULATIONAHA.120.04636... |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | cardiovascular disease, carotid intima-media thickness, clinical trials as topic, surrogate marker, meta-analysis, BASE-LINE CHARACTERISTICS, TYPE-2 DIABETES-MELLITUS, IMPAIRED GLUCOSE-TOLERANCE, CORONARY-HEART-DISEASE, JAPAN STATIN TREATMENT, LDL TREATMENT STRATEGIES, EXTENDED-RELEASE NIACIN, ESTROGEN PLUS PROGESTIN, ARTERIAL-WALL THICKNESS, HIV-INFECTED PATIENTS |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10120589 |
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