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Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study

Wang X 1 , Dalmeijer GW 1 , den Ruijter HM 2 , Anderson TJ 3 , Britton AR 4 , Dekker J 5 Show all authors , Engström G 6 , Evans GW 7 , de Graaf J 8 , Grobbee DE 1 , Hedblad B 6 , Holewijn S 8 , Ikeda A 9 , Kauhanen J 10 , Kitagawa K 11 , Kitamura A 9 , Kurl S 10 , Lonn EM 12 , Lorenz MW 13 , Mathiesen EB 14 , Nijpels G 5 , Okazaki S 15 , Polak JF 16 , Price JF 17 , Rembold CM 18 , Rosvall M 6 , Rundek T 19 , Salonen JT 20 , Sitzer M 21 , Stehouwer CD 22 , Tuomainen TP 10 , Peters SA 23 , Bots ML 1

Affiliations 

  • 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,Utrecht, the Netherlands
  • 2 Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
  • 3 Department of Cardiac Sciences and Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
  • 4 Department of Epidemiology and Public Health University College London, London, United Kingdom
  • 5 Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  • 6 Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
  • 7 Department of Biostatistical Sciences and Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
  • 8 Department of General Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
  • 9 Osaka Medical Center for Health Science and Promotion, Osaka, Japan
  • 10 The Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
  • 11 Department of Neurology, Tokyo Women Medical University, Tokyo, Japan
  • 12 Department of Medicine, Division of Cardiology and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
  • 13 Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany
  • 14 Brain and Circulation Research Group, Department of Clinical Medicine, University of Tromsö, Tromsö, Norway
  • 15 Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
  • 16 Department of Radiology, Tufts University School of Medicine, Boston, United States of America
  • 17 Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
  • 18 Cardiology Division, Department of Internal Medicine, University of Virginia, Charlottesville, VA, United States of America
  • 19 Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fl, United States of America
  • 20 Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  • 21 Department of Neurology, University Hospital, Goethe-University, Frankfurt am Main, Germany and Department of Neurology Klinikum Herford, Germany
  • 22 Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
  • 23 The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
PLoS One, 2017;12(3):e0173393.
PMID: 28323823 DOI: 10.1371/journal.pone.0173393

Abstract

BACKGROUND: The relation of a single risk factor with atherosclerosis is established. Clinically we know of risk factor clustering within individuals. Yet, studies into the magnitude of the relation of risk factor clusters with atherosclerosis are limited. Here, we assessed that relation.

METHODS: Individual participant data from 14 cohorts, involving 59,025 individuals were used in this cross-sectional analysis. We made 15 clusters of four risk factors (current smoking, overweight, elevated blood pressure, elevated total cholesterol). Multilevel age and sex adjusted linear regression models were applied to estimate mean differences in common carotid intima-media thickness (CIMT) between clusters using those without any of the four risk factors as reference group.

RESULTS: Compared to the reference, those with 1, 2, 3 or 4 risk factors had a significantly higher common CIMT: mean difference of 0.026 mm, 0.052 mm, 0.074 mm and 0.114 mm, respectively. These findings were the same in men and in women, and across ethnic groups. Within each risk factor cluster (1, 2, 3 risk factors), groups with elevated blood pressure had the largest CIMT and those with elevated cholesterol the lowest CIMT, a pattern similar for men and women.

CONCLUSION: Clusters of risk factors relate to increased common CIMT in a graded manner, similar in men, women and across race-ethnic groups. Some clusters seemed more atherogenic than others. Our findings support the notion that cardiovascular prevention should focus on sets of risk factors rather than individual levels alone, but may prioritize within clusters.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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