Vol. 144 No. 4344 (2014)
Early detection of subjects at risk for vascular remodelling – results from the Swiss population-based study SAPALDIA
- Julia Dratva
- Seraina Caviezel
- Emmanuel Schaffner
- Elisabeth Zemp
- Eric de Groot
- Arno Schmidt-Trucksäss
- Robert Bettschart
- Lanja Saleh
- Alexander Turk
- Jean-Michel Gaspoz
- David Carballo
- Nino Kuenzli
- Nicole Probst-Hensch
QUESTIONS UNDER STUDY: As the burden of cardiovascular disease (CVD) increases globally, its prevention and risk assessment becomes ever more important. We thus investigated the longitudinal association of the cardiovascular risk scores in the population-based cohort SAPALDIA with carotid intima media thickening (CIMT), an indicator of sub-clinical disease, and CVD incidence.
METHODS: In 2,832 SAPALDIA participants, the Swiss and ESC heart risk score (AGLA, SCORE) were calculated based on 2001 data and CIMT was measured in 2010/11. We ran multi-level linear regression analyses between scores and CIMT, stratified for CVD status and gender, and logistic analyses for doctor-diagnosed CVD incidence. Path analyses investigated direct and indirect effects on CIMT.
RESULTS: AGLA and SCORE were positively associated with increasing CIMT in both healthy and CVD diagnosed subjects and men and women. Participants in highest risk categories showed a significant CIMT difference of >0.20 mm compared to the reference risk category (<1%), even larger in CVD healthy subjects and men. With increasing risk the odds of CVD incidence increased (Ref. <1%; 10 yr. risk AGLA >10% OR 2.1, >20% OR 3.7). Path analyses yield risk factors’ direct and indirect effects through blood pressure.
CONCLUSION: The positive longitudinal association between risk estimations and CIMT confirms the use of risk scores in assessing individuals and populations at risk. Systolic blood pressure appears to be a main pathological mechanism, underscoring the importance of optimal blood pressure control and the importance of prevention strategies of risk factors, indirectly affecting CIMT through the haemodynamic pathway.
- Unal B, Critchley JA, Capewell S. Explaining the Decline in Coronary Heart Disease Mortality in England and Wales Between 1981 and 2000. Circulation. 2004;109(9):1101–7.
- Kahn R, Robertson RM, Smith R, Eddy D. The Impact of Prevention on Reducing the Burden of Cardiovascular Disease. Circulation. 2008;118(5):576–85.
- Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2197–223.
- Gohlke H. Primary prevention of coronary artery disease: is there a role for risk scores? Herz. 2012;37(1):75–80.
- Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24(11):987–1003.
- Assmann G, Cullen P, Schulte H. Simple Scoring Scheme for Calculating the Risk of Acute Coronary Events Based on the 10–Year Follow-Up of the Prospective Cardiovascular Münster (PROCAM) Study. Circulation. 2002;105(3):310–5.
- Campuzano R, Moya JL, Garcia-Lledo A, Tomas JP, Ruiz S, Megias A, et al. Endothelial dysfunction, intima-media thickness and coronary reserve in relation to risk factors and Framingham score in patients without clinical atherosclerosis. J Hypertens. 2006;24(8):1581–8.
- Nambi V, Chambless L, He M, Folsom AR, Mosley T, Boerwinkle E, et al. Common carotid artery intimaâ€“media thickness is as good as carotid intimaâ€“media thickness of all carotid artery segments in improving prediction of coronary heart disease risk in the Atherosclerosis Risk in Communities (ARIC) study. Eur Heart J. 2012;33(2):183–90.
- Baldassarre D, Hamsten A, Veglia F, de Faire U, Humphries SE, Smit AJ, et al. Measurements of Carotid Intima-Media Thickness and of Interadventitia Common Carotid Diameter Improve Prediction of Cardiovascular Events: Results of the IMPROVE (Carotid Intima Media Thickness [IMT] and IMT-Progression as Predictors of Vascular Events in a High Risk European Population) Study. J Am Coll Cardiol. 2012;60(16):1489–99.
- Costanzo P, Perrone-Filardi P, Vassallo E, Paolillo S, Cesarano P, Brevetti G, et al. Does carotid intima-media thickness regression predict reduction of cardiovascular events? A meta-analysis of 41 randomized trials. J Am Coll Cardiol. 2010;56(24):2006–20.
- Lorenz MW, Polak JF, Kavousi M, Mathiesen EB, Volzke H, Tuomainen TP, et al. Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data. Lancet. 2012;379(9831):2053–62.
- Kieltyka L, Urbina EM, Tang R, Bond MG, Srinivasan SR, Berenson GS. Framingham risk score is related to carotid artery intima-media thickness in both white and black young adults: the Bogalusa Heart Study. Atherosclerosis. 2003;170(1):125–30.
- Raiko JR, Magnussen CG, Kivimaki M, Taittonen L, Laitinen T, Kahonen M, et al. Cardiovascular risk scores in the prediction of subclinical atherosclerosis in young adults: evidence from the cardiovascular risk in a young Finns study. Eur J Cardiovasc Prev Rehabil. 2010;17(5):549–55.
- von Sarnowski B, Lüdemann J, Völzke H, Dörr M, Kessler C, Schminke U. Common Carotid Intima-Media Thickness and Framingham Risk Score Predict Incident Carotid Atherosclerotic Plaque Formation: Longitudinal Results From the Study of Health in Pomerania. Stroke. 2010;41(10):2375–7.
- Herder M, Johnsen SH, Arntzen KA, Mathiesen EB. Risk Factors for Progression of Carotid Intima-Media Thickness and Total Plaque Area: A 13–Year Follow-Up Study: The Tromsø Study. Stroke. 2012;43(7):1818–23.
- Ackermann-Liebrich U, Kuna-Dibbert B, Probst-Hensch NM, Schindler C, Felber Dietrich D, Stutz EZ, et al. Follow-up of the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA 2) 1991–2003: methods and characterization of participants. Soz Praventivmed. 2005;50(4):245–63.
- Martin BW, Ackermann-Liebrich U, Leuenberger P, Kunzli N, Stutz EZ, Keller R, et al. SAPALDIA: methods and participation in the cross-sectional part of the Swiss Study on Air Pollution and Lung Diseases in Adults. Soz Praventivmed. 1997;42(2):67–84.
- Teynor A, Caviezel S, Dratva J, Kunzli N, Schmidt-Trucksass A. An automated, interactive analysis system for ultrasound sequences of the common carotid artery. Ultrasound Med Biol. 2012;38(8):1440–50.
- Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al. Mannheim carotid intima-media thickness and plaque consensus (2004–2006–2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34(4):290–6.
- Caviezel S, Dratva J, Schaffner E, Teynor A, Baumstark MW, Schindler C, et al. Variability and reproducibility of carotid structural and functional parameters assessed with transcutaneous ultrasound – Results from the SAPALDIA Cohort Study. Atherosclerosis. 2013;231(2):448–55.
- Felber Dietrich D, Schindler C, Schwartz J, Barthélémy J-C, Tschopp J-M, Roche F, et al. Heart rate variability in an ageing population and its association with lifestyle and cardiovascular risk factors: results of the SAPALDIA study. Europace. 2006;8(7):521–9.
- Dratva J, Zemp E, Staedele P, Schindler C, Constanza MC, Gerbase M, et al. Variability of reproductive history across the Swiss SAPALDIA cohort--patterns and main determinants. Ann Hum Biol. 2007;34(4):437–53.
- Dratva J, Gomez Real F, Schindler C, Ackermann-Liebrich U, Gerbase MW, Probst-Hensch NM, et al. Is age at menopause increasing across Europe? Results on age at menopause and determinants from two population-based studies. Menopause. 2009;16(2):385–94.
- Everitt BS, Dunn G. Applied multivariate data analysis 2nd ed. London: Arnold 2001.
- Bernini GP, Moretti A, Sgro M, Argenio GF, Barlascini CO, Cristofani R, et al. Influence of endogenous androgens on carotid wall in postmenopausal women. Menopause. 2001;8(1):43–50.
- Nabulsi AA, Folsom AR, White A, Patsch W, Heiss G, Wu KK, et al. Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women. The Atherosclerosis Risk in Communities Study Investigators. N Engl J Med. 1993;328(15):1069–75.
- Meadows JL, Vaughan DE. Endothelial biology in the post-menopausal obese woman. Maturitas. 2011;69(2):120–5.
- Muscelli E, Kozakova M, Flyvbjerg A, Kyriakopoulou K, Astiarraga BD, Glintborg D, et al. The effect of menopause on carotid artery remodeling, insulin sensitivity, and plasma adiponectin in healthy women. Am J Hypertens. 2009;22(4):364–70.
- Femia R, Kozakova M, Nannipieri M, Gonzales-Villalpando C, Stern MP, Haffner SM, et al. Carotid Intima-Media Thickness in Confirmed Prehypertensive Subjects: Predictors and Progression. Arteriosclerosis, Thrombosis, and Vascular Biology. 2007;27(10):2244–9.
- Kerkhof GF, Duivenvoorden HJ, Leunissen RW, Hokken-Koelega AC. Pathways leading to atherosclerosis: a structural equation modeling approach in young adults. Hypertension. 2011;57(2):255–60.
- Kotseva K, Wood D, De Backer G, De Bacquer D, Pyorala K, Keil U, et al. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet. 2009;373(9667):929–40.
- Banegas JR, Lopez-Garcia E, Dallongeville J, Guallar E, Halcox JP, Borghi C, et al. Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. Eur Heart J. 2011;32(17):2143–52.
- Kaess BM, Rong J, Larson MG, Hamburg NM, Vita JA, Levy D, et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012;308(9):875–81.
- Schmitz G, Torzewski M. Atherosclerosis: an inflammatory disease. In: Mehta JL, editor. Inflammatory and Infectious Baseis of Atherosclerosis. Basel: Birkhäuser Verlag 2001. p. 1–21.
- Den Ruijter HM, Peters SA, Anderson TJ, Britton AR, Dekker JM, Eijkemans MJ, et al. Common carotid intima-media thickness measurements in cardiovascular risk prediction: a meta-analysis. JAMA. 2012;308(8):796–803.
- Elias-Smale SE, Kavousi M, Verwoert GC, Koller MT, Steyerberg EW, Mattace-Raso FU, et al. Common carotid intima-media thickness in cardiovascular risk stratification of older people: the Rotterdam Study. Eur J Prev Cardiol. 2012;19(4):698–705.
- Bots ML, Groenewegen KA, Anderson TJ, Britton AR, Dekker JM, Engstrom G, et al. Common carotid intima-media thickness measurements do not improve cardiovascular risk prediction in individuals with elevated blood pressure: the USE-IMT collaboration. Hypertension. 2014;63(6):1173–81.
- Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33(13):1635–701.
- Romanens M, Ackermann F, Sudano I, Szucs T, Spence JD. Arterial age as a substitute for chronological age in the AGLA risk function could improve coronary risk prediction. Swiss Med Wkly. 2014;144:w13967.
- Inaba Y, Chen JA, Bergmann SR. Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: A meta-analysis. Atherosclerosis. 2012;220(1):128–33.
- Wannarong T, Parraga G, Buchanan D, Fenster A, House AA, Hackam DG, et al. Progression of carotid plaque volume predicts cardiovascular events. Stroke. 2013;44(7):1859–65.
- Finn AV, Kolodgie FD, Virmani R. Correlation Between Carotid Intimal/Medial Thickness and Atherosclerosis: A Point of View From Pathology. Arterioscler Thromb Vasc Biol. 2010;30(2):177–81.
- Bots ML, Hofman A, De Jong PT, Grobbee DE. Common carotid intima-media thickness as an indicator of atherosclerosis at other sites of the carotid artery. The Rotterdam Study. Ann Epidemiol. 1996;6(2):147–53.