Carotid stiffness is associated with incident stroke: a systematic review and individual participant data meta-analysis

Thomas T van Sloten; Sanaz Sedaghat; Stéphane Laurent; Gérard M London; Bruno Pannier; M Arfan Ikram; Maryam Kavousi; Francesco Mattace-Raso; Oscar H Franco; Pierre Boutouyrie; Coen D A Stehouwer

doi:10.1016/j.jacc.2015.08.888

Carotid stiffness is associated with incident stroke: a systematic review and individual participant data meta-analysis

Thomas T van Sloten, Sanaz Sedaghat, Stéphane Laurent, Gérard M London, Bruno Pannier, M Arfan Ikram, Maryam Kavousi, Francesco Mattace-Raso, Oscar H Franco, Pierre Boutouyrie, Coen D A Stehouwer

Research output: Contribution to journal › Review article › peer-review

Abstract

BACKGROUND: Carotid stiffening is considered a key element in the pathogenesis of stroke. However, results of studies evaluating the association between carotid stiffness and incident stroke have been inconsistent.

OBJECTIVES: This study investigated whether carotid stiffness (as determined by ultrasonography) is associated with incident stroke and whether this association is independent of aortic stiffness as estimated by carotid-femoral pulse wave velocity (cfPWV). Additionally, we evaluated the incremental value of carotid stiffness for stroke risk prediction beyond Framingham risk factors and cfPWV.

METHODS: This study included a systematic review and meta-analyses of aggregate and individual participant data (IPD), the latter of which was obtained by requesting individual-level data of all cohort studies with available data on carotid stiffness and cfPWV.

RESULTS: Ten studies (n = 22,472) were included in the aggregate data meta-analysis and 4 (n = 4,540) in the IPD meta-analysis. After adjusting for cardiovascular (CV) factors, the aggregate data meta-analysis showed that greater carotid stiffness (per SD) was associated with stroke (hazard ratio: 1.18; 95% confidence interval: 1.05 to 1.33). In addition, carotid stiffness was associated with total CV events and CV and all-cause mortality, but not with coronary heart disease events. In the IPD meta-analysis, additional adjustment for cfPWV did not materially change these associations. Carotid stiffness did improve stroke risk prediction beyond Framingham and cfPWV (integrative discrimination improvement: 0.4 percentage point [95% confidence interval: 0.1 to 0.6 percentage point] and continuous net reclassification improvement: 18.6% [95% confidence interval: 5.8% to 31.3%]).

CONCLUSIONS: Carotid stiffness is associated with incident stroke independently of CV factors and aortic stiffness. In addition, carotid stiffness improves stroke risk prediction beyond Framingham and aortic stiffness.

Original language	English
Pages (from-to)	2116-2125
Number of pages	10
Journal	Journal of the American College of Cardiology
Volume	66
Issue number	19
DOIs	https://doi.org/10.1016/j.jacc.2015.08.888
Publication status	Published - 10 Nov 2015
Externally published	Yes

Keywords

Carotid Arteries/diagnostic imaging
Global Health
Humans
Incidence
Risk Factors
Stroke/epidemiology
Ultrasonography
Vascular Stiffness

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10.1016/j.jacc.2015.08.888

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van Sloten, T. T., Sedaghat, S., Laurent, S., London, G. M., Pannier, B., Ikram, M. A., Kavousi, M., Mattace-Raso, F., Franco, O. H., Boutouyrie, P., & Stehouwer, C. D. A. (2015). Carotid stiffness is associated with incident stroke: a systematic review and individual participant data meta-analysis. Journal of the American College of Cardiology, 66(19), 2116-2125. https://doi.org/10.1016/j.jacc.2015.08.888

@article{6acae22ea3414e79af533e1b707de01f,

title = "Carotid stiffness is associated with incident stroke: a systematic review and individual participant data meta-analysis",

abstract = "BACKGROUND: Carotid stiffening is considered a key element in the pathogenesis of stroke. However, results of studies evaluating the association between carotid stiffness and incident stroke have been inconsistent.OBJECTIVES: This study investigated whether carotid stiffness (as determined by ultrasonography) is associated with incident stroke and whether this association is independent of aortic stiffness as estimated by carotid-femoral pulse wave velocity (cfPWV). Additionally, we evaluated the incremental value of carotid stiffness for stroke risk prediction beyond Framingham risk factors and cfPWV.METHODS: This study included a systematic review and meta-analyses of aggregate and individual participant data (IPD), the latter of which was obtained by requesting individual-level data of all cohort studies with available data on carotid stiffness and cfPWV.RESULTS: Ten studies (n = 22,472) were included in the aggregate data meta-analysis and 4 (n = 4,540) in the IPD meta-analysis. After adjusting for cardiovascular (CV) factors, the aggregate data meta-analysis showed that greater carotid stiffness (per SD) was associated with stroke (hazard ratio: 1.18; 95% confidence interval: 1.05 to 1.33). In addition, carotid stiffness was associated with total CV events and CV and all-cause mortality, but not with coronary heart disease events. In the IPD meta-analysis, additional adjustment for cfPWV did not materially change these associations. Carotid stiffness did improve stroke risk prediction beyond Framingham and cfPWV (integrative discrimination improvement: 0.4 percentage point [95% confidence interval: 0.1 to 0.6 percentage point] and continuous net reclassification improvement: 18.6% [95% confidence interval: 5.8% to 31.3%]).CONCLUSIONS: Carotid stiffness is associated with incident stroke independently of CV factors and aortic stiffness. In addition, carotid stiffness improves stroke risk prediction beyond Framingham and aortic stiffness.",

keywords = "Carotid Arteries/diagnostic imaging, Global Health, Humans, Incidence, Risk Factors, Stroke/epidemiology, Ultrasonography, Vascular Stiffness",

author = "{van Sloten}, {Thomas T} and Sanaz Sedaghat and St{\'e}phane Laurent and London, {G{\'e}rard M} and Bruno Pannier and Ikram, {M Arfan} and Maryam Kavousi and Francesco Mattace-Raso and Franco, {Oscar H} and Pierre Boutouyrie and Stehouwer, {Coen D A}",

year = "2015",

month = nov,

day = "10",

doi = "10.1016/j.jacc.2015.08.888",

language = "English",

volume = "66",

pages = "2116--2125",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier",

number = "19",

}

van Sloten, TT, Sedaghat, S, Laurent, S, London, GM, Pannier, B, Ikram, MA, Kavousi, M, Mattace-Raso, F, Franco, OH, Boutouyrie, P & Stehouwer, CDA 2015, 'Carotid stiffness is associated with incident stroke: a systematic review and individual participant data meta-analysis', Journal of the American College of Cardiology, vol. 66, no. 19, pp. 2116-2125. https://doi.org/10.1016/j.jacc.2015.08.888

TY - JOUR

T1 - Carotid stiffness is associated with incident stroke

T2 - a systematic review and individual participant data meta-analysis

AU - van Sloten, Thomas T

AU - Sedaghat, Sanaz

AU - Laurent, Stéphane

AU - London, Gérard M

AU - Pannier, Bruno

AU - Ikram, M Arfan

AU - Kavousi, Maryam

AU - Mattace-Raso, Francesco

AU - Franco, Oscar H

AU - Boutouyrie, Pierre

AU - Stehouwer, Coen D A

PY - 2015/11/10

Y1 - 2015/11/10

N2 - BACKGROUND: Carotid stiffening is considered a key element in the pathogenesis of stroke. However, results of studies evaluating the association between carotid stiffness and incident stroke have been inconsistent.OBJECTIVES: This study investigated whether carotid stiffness (as determined by ultrasonography) is associated with incident stroke and whether this association is independent of aortic stiffness as estimated by carotid-femoral pulse wave velocity (cfPWV). Additionally, we evaluated the incremental value of carotid stiffness for stroke risk prediction beyond Framingham risk factors and cfPWV.METHODS: This study included a systematic review and meta-analyses of aggregate and individual participant data (IPD), the latter of which was obtained by requesting individual-level data of all cohort studies with available data on carotid stiffness and cfPWV.RESULTS: Ten studies (n = 22,472) were included in the aggregate data meta-analysis and 4 (n = 4,540) in the IPD meta-analysis. After adjusting for cardiovascular (CV) factors, the aggregate data meta-analysis showed that greater carotid stiffness (per SD) was associated with stroke (hazard ratio: 1.18; 95% confidence interval: 1.05 to 1.33). In addition, carotid stiffness was associated with total CV events and CV and all-cause mortality, but not with coronary heart disease events. In the IPD meta-analysis, additional adjustment for cfPWV did not materially change these associations. Carotid stiffness did improve stroke risk prediction beyond Framingham and cfPWV (integrative discrimination improvement: 0.4 percentage point [95% confidence interval: 0.1 to 0.6 percentage point] and continuous net reclassification improvement: 18.6% [95% confidence interval: 5.8% to 31.3%]).CONCLUSIONS: Carotid stiffness is associated with incident stroke independently of CV factors and aortic stiffness. In addition, carotid stiffness improves stroke risk prediction beyond Framingham and aortic stiffness.

AB - BACKGROUND: Carotid stiffening is considered a key element in the pathogenesis of stroke. However, results of studies evaluating the association between carotid stiffness and incident stroke have been inconsistent.OBJECTIVES: This study investigated whether carotid stiffness (as determined by ultrasonography) is associated with incident stroke and whether this association is independent of aortic stiffness as estimated by carotid-femoral pulse wave velocity (cfPWV). Additionally, we evaluated the incremental value of carotid stiffness for stroke risk prediction beyond Framingham risk factors and cfPWV.METHODS: This study included a systematic review and meta-analyses of aggregate and individual participant data (IPD), the latter of which was obtained by requesting individual-level data of all cohort studies with available data on carotid stiffness and cfPWV.RESULTS: Ten studies (n = 22,472) were included in the aggregate data meta-analysis and 4 (n = 4,540) in the IPD meta-analysis. After adjusting for cardiovascular (CV) factors, the aggregate data meta-analysis showed that greater carotid stiffness (per SD) was associated with stroke (hazard ratio: 1.18; 95% confidence interval: 1.05 to 1.33). In addition, carotid stiffness was associated with total CV events and CV and all-cause mortality, but not with coronary heart disease events. In the IPD meta-analysis, additional adjustment for cfPWV did not materially change these associations. Carotid stiffness did improve stroke risk prediction beyond Framingham and cfPWV (integrative discrimination improvement: 0.4 percentage point [95% confidence interval: 0.1 to 0.6 percentage point] and continuous net reclassification improvement: 18.6% [95% confidence interval: 5.8% to 31.3%]).CONCLUSIONS: Carotid stiffness is associated with incident stroke independently of CV factors and aortic stiffness. In addition, carotid stiffness improves stroke risk prediction beyond Framingham and aortic stiffness.

KW - Carotid Arteries/diagnostic imaging

KW - Global Health

KW - Humans

KW - Incidence

KW - Risk Factors

KW - Stroke/epidemiology

KW - Ultrasonography

KW - Vascular Stiffness

U2 - 10.1016/j.jacc.2015.08.888

DO - 10.1016/j.jacc.2015.08.888

M3 - Review article

C2 - 26541923

SN - 0735-1097

VL - 66

SP - 2116

EP - 2125

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 19

ER -

Carotid stiffness is associated with incident stroke: a systematic review and individual participant data meta-analysis

Abstract

Keywords

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