Progression of conventional cardiovascular risk factors and vascular disease risk in individuals: insights from the PROG-IMT consortium
Authors: Bahls Martin , Lorenz Matthias W , Dörr Marcus , Gao Lu , Kitagawa Kazuo , Tuomainen Tomi-Pekka , Agewall Stefan , Berenson Gerald , Catapano Alberico L , Norata Giuseppe D , Bots Michiel L , van Gilst Wiek , Asselbergs Folkert W , Brouwers Frank P , Uthoff Heiko , Sander Dirk , Poppert Holger , Hecht Olsen Michael , Empana Jean Philippe , Schminke Ulf , Baldassarre Damiano , Veglia Fabrizio , Franco Oscar H , Kavousi Maryam , de Groot Eric , Mathiesen Ellisiv B , Grigore Liliana , Polak Joseph F , Rundek Tatjana , Stehouwer Coen DA , Skilton Michael R , Hatzitolios Apostolos I , Savopoulos Christos , Ntaios George , Plichart Matthieu , McLachlan Stela , Lind Lars , Willeit Peter , Steinmetz Helmuth , Desvarieux Moise , Ikram M Arfan , Johnsen Stein Harald , Schmidt Caroline , Willeit Johann , Ducimetiere Pierre , Price Jackie F , Bergström Göran , Kauhanen Jussi , Kiechl Stefan , Sitzer Matthias , Bickel Horst , Sacco Ralph L , Hofman Albert , Völzke Henry , Thompson Simon G ,   on behalf of the PROG-IMT Study Group
Published: October 2019

Aims

Averaged measurements, but not the progression based on multiple assessments of carotid intima-media thickness, (cIMT) are predictive of cardiovascular disease (CVD) events in individuals. Whether this is true for conventional risk factors is unclear.

Methods and results

An individual participant meta-analysis was used to associate the annualised progression of systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol with future cardiovascular disease risk in 13 prospective cohort studies of the PROG-IMT collaboration ( n = 34,072). Follow-up data included information on a combined cardiovascular disease endpoint of myocardial infarction, stroke, or vascular death. In secondary analyses, annualised progression was replaced with average. Log hazard ratios per standard deviation difference were pooled across studies by a random effects meta-analysis. In primary analysis, the annualised progression of total cholesterol was marginally related to a higher cardiovascular disease risk (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.00 to 1.07). The annualised progression of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol was not associated with future cardiovascular disease risk. In secondary analysis, average systolic blood pressure (HR 1.20 95% CI 1.11 to 1.29) and low-density lipoprotein cholesterol (HR 1.09, 95% CI 1.02 to 1.16) were related to a greater, while high-density lipoprotein cholesterol (HR 0.92, 95% CI 0.88 to 0.97) was related to a lower risk of future cardiovascular disease events.

Conclusion

Averaged measurements of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol displayed significant linear relationships with the risk of future cardiovascular disease events. However, there was no clear association between the annualised progression of these conventional risk factors in individuals with the risk of future clinical endpoints.