Carotid intima-media thickness-defined early vascular aging increased MACE risk (HR 1.36; 95% CI 1.08-1.72), and adding it to conventional models improved risk prediction (NRI 9.77%, p<0.001).
Cohort (n=33,731)
Yes
Does cIMT-based vascular aging phenotyping improve cardiovascular risk prediction beyond conventional risk scores in UK Biobank participants?
Integrating cIMT-based vascular aging phenotypes into conventional risk models significantly enhances predictive accuracy for major adverse cardiovascular events.
Effect estimate: HR 1.36 (95% CI 1.08-1.72)
Abstract Background The role of carotid intima-media thickness (cIMT) in defining vascular aging phenotypes remains unexplored, limiting its integration into personalized cardiovascular risk prediction. Purpose This study aimed to evaluate the role of carotid cIMT as a biomarker for early vascular aging (EVA) and supernormal vascular aging (SUPERNOVA), and to develop a cIMT-based vascular age model to improve cardiovascular risk prediction beyond conventional risk scores. Methods This prospective cohort study included 33,731 UK biobank participants who underwent carotid ultrasound between 2014 and 2020. Vascular age was modeled using cIMT and traditional risk factors. The residual-based Δ-age was calculated to categorize individuals into EVA (Δ-age 90th percentile), SUPERNOVA (Δ-age 10th percentile), and normal vascular aging (reference). Cox proportional hazards models adjusted for age, sex, and Framingham risk score were used to assess the associations of vascular aging phenotypes with major adverse cardiovascular events (MACE). Model performance was evaluated using the C-index, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results Over a median follow-up of 3.3 years, 569 MACE were observed. After multivariable adjustment, EVA individuals exhibited a 36% increased risk of MACE (HR: 1.36, 95% CI: 1.08–1.72), while SUPERNOVA individuals showed a 34% reduced risk (HR: 0.66, 95% CI: 0.47–0.94). Each 0.1 mm increase in cIMT was associated with an 18% higher MACE risk (HR: 1.18, 95% CI: 1.10–1.25). Adding vascular age to the conventional model significantly improved risk prediction, with a ΔC-statistic of 0.010 (p = 0.038) and a NRI of 9.77% (p 0.001). Conclusion cIMT serves as a robust morphological marker of vascular aging, effectively stratifying individuals into EVA and SUPERNOVA phenotypes with distinct cardiovascular risks. Integrating cIMT into risk models enhances predictive accuracy and supports early intervention strategies for high-risk populations.Table 1 Table 2
Dong et al. (Sat,) conducted a cohort in Cardiovascular risk (n=33,731). Carotid intima-media thickness (cIMT) vascular age model vs. Normal vascular aging / Conventional risk scores was evaluated on Major adverse cardiovascular events (MACE) (HR 1.36, 95% CI 1.08-1.72). Carotid intima-media thickness-defined early vascular aging increased MACE risk (HR 1.36; 95% CI 1.08-1.72), and adding it to conventional models improved risk prediction (NRI 9.77%, p<0.001).
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