Supplementary Online Content

Transcription

1 Supplementary Online Content Den Ruijter HM, Peters SA, Anderson TJ, et al. Common carotid intimamedia thickness measurements in cardiovascular risk prediction. JAMA. doi: /jama etable 1. Common CIMT (SD) distribution across age categories among men and women in the cohorts in USEIMT etable 2. Relation of individual cardiovascular risk factors in the Framingham risk score with firsttime myocardial infarction or stroke in a model with and without common carotid intimamedia thickness efigure 1. Flow diagram of selection of studies for inclusion in metaanalysis efigure 2. Goodness of fit of the models with and without common CIMT efigure 3. Reclassification with CIMT, added to Framingham risk score in men efigure 4. Reclassification with CIMT, added to Framingham risk score in women efigure 5. Reclassification after CIMT, added to Framingham risk score using 4 risk categories This supplementary material has been provided by the authors to give readers additional information about their work.

2 etable 1. Common CIMT (SD) distribution across age categories among men and women in the cohorts in USEIMT. Age category Gender ARIC 1994 CAPS 2006 Charlott esville 2006 CHS 2007 FATE 2011 Hoorn 2003 KIHD 1991 Malmö 2000 MESA 2007 Nijmegen 2009 NOMAS 2007 OSACA Rotterdam 1997 Tromsø Men Women 0.67 (0.089) 0.64 (0.077) (0.145) 0.71 (0.116) 0.63 (0.116) 0.57 (0.085) 0.66 (0.096) 0.60 (0.026) 0.66 (0.046) 0.59 (0.103) 0.64 (0.127) 0.63 (0.078) 0.60 (0.070) 4555 Men Women 0.64 (0.131) 0.60 (0.126) 0.73 (0.134) 0.70 (0.099) (0.170) 0.74 (0.122) 0.70 (0.148) (0.126) 0.60 () 0.73 (0.141) 0.70 (0.113) 0.68 (0.132) 0.64 (0.125) 0.78 (0.083) 0.75 (0.063) 0.69 (0.086) 0.68 (0.078) 0.77 (0.147) 0.71 (0.167) (0.116) 0.67 (0.098) 5565 Men Women (0.160) 0.67 (0.431) (0.150) (0.121) 0.87 (0.184) 0.81 (0.137) (0.191) (0.162) (0.119) 0.82 (0.164) 0.81 (0.172) (0.128) (0.152) (0.130) (0.104) (0.091) 0.70 (0.084) 0.68 (0.076) 0.90 (0.322) (0.224) (0.129) 0.69 (0.126) 0.79 (0.134) 0.73 (0.120) 6575 Men Women 0.89 (0.200) (0.140) 0.91 (0.161) 0.87 (0.188) 0.88 (0.162) (0.148) 0.90 (0.216) 0.88 (0.157) (0.145) 0.85 (0.184) 0.81 (0.139) 0.86 (0.174) (0.162) 0.90 (0.113) 0.87 (0.106) 0.75 (0.094) (0.083) 0.93 (0.284) 0.88 (0.192) 0.82 (0.145) (0.123) 0.89 (0.158) (0.148) Mean common CIMT across age categories in the separate cohorts in men (top panel) and women (bottom panel). ARIC denotes Atherosclerosis Risk in Communities. CAPS denotes Carotid Atherosclerosis Progression. CHS denotes Cardiovascular Health. Malmö denotes the Malmö Diet and Cancer. MESA denotes the MultiEthnic of Atherosclerosis. KIHD denotes the Kuopio Ischaemic Heart Disease Risk Factor. OSACA2 denotes the Osaka FollowUp for Carotid Atherosclerosis 2, NOMAS denotes the Northern Manhattan. FATE denotes the Firefighters and Their Endothelium. Nijmegen denotes the Nijmegen Biomedical.

3 etable 2. Relation of individual cardiovascular risk factors in the Framingham risk score with firsttime myocardial infarction or stroke in a model with and without common carotid intimamedia thickness. Model with Framingham risk factors Model with Framingham risk factors and carotid intimamedia thickness Risk factor Numbers of firsttime myocardial infarction or stroke Hazard ratio (95% confidence interval) Hazard ratio (95% confidence interval) Sex, men (n=21,730) versus women (n=24,098) Men: 2,298 Women: 1, ( ) 1.51 ( ) Age, per 1 year increase 1.06 ( ) 1.06 ( ) Systolic blood pressure, per 1 mmhg increase Treatment for high blood pressure, yes (n=10,833) versus no (n=34,995) Total cholesterol, per 1 mmol/l HDLcholesterol, per 1 mmol/l Diabetes, present (n=5,131) versus absent (n=40,697) Current cigarette smoking, yes (n=10,211) versus no (n=35,617) Common CIMT, per increase of 0.1 mm* Common CIMT, per increase of 1 sd* On treatment: 1,206 Not on treatment: 2,745 Diabetes: 782 No diabetes: 3,225 Smoking: 1,207 No smoking: 2, ( ) 1.02 ( ) 1.34 ( ) 1.34 ( ) 1.14 ( ) 1.13 ( ) 0.61 ( ) 0.62 ( ) 1.74 ( ) 1.69 ( ) 1.73 ( ) 1.69 ( ) 1.09 ( ) 1.16 ( ) HDL, highdensity lipoprotein; CIMT, common carotid intimamedia thickness. * CIMT variables were not both included in one model, but these results reflect two different models. *number of events

4 efigure 1. Flow diagram of selection of studies for inclusion in metaanalysis. Search query: english:la AND ('incidence':de OR 'mortality':de OR 'follow up studies':de OR prognos*.tw OR predict*.tw OR course*.tw) AND (carotid*:ab,ti OR imt:ab,ti OR 'intimal medical thickness':ab,ti OR 'intima media thickness':ab,ti) NOT ('stenting'/exp OR 'stenting') NOT ('carotid endarterectomy'/exp OR 'carotid endarterectomy') AND (risk*:ab,ti NOT 'risk factors':ab,ti OR 'cardiovascular disease':ab,ti OR predict*:ab,ti OR 'coronary heart disease':ab,ti OR 'cerebrovascular disease':ab,ti OR stroke:ab,ti OR 'myocardial infarction':ab,ti OR events:ab,ti) AND [english]/lim AND [article]/lim

5 efigure 2. Goodness of fit of the models with and without common CIMT. Predicted versus observed 10year absolute risks estimated with Kaplan Meier to develop a first time myocardial infarction or stroke in the baseline model with the refit Framingham risk variables (Panel A) and in the model with the addition of logtransformed common CIMT measurements (Panel B). Note that the four points are the averaged values of four risk categories (<5%, 5 to <10%, 10 to <20%, 20%). Dashed lines indicate the upper and lower limits of the observed risks as estimated with Kaplan Meier.

6 efigure 3. Reclassification with CIMT, added to Framingham risk score in men. Figure with numbers of men with and without events (A) classified according to their 10year absolute risk to develop a myocardial infarction or stroke predicted with the Framingham risk score variables (rows) or classified according to their 10year absolute risk to develop a myocardial infarction or cerebrovascular event predicted with the Framingham risk score and a common CIMT measurement (columns). The observed Kaplan Meier absolute risk estimates (B) for all men (with and without events) are shown in the bottom table. *indicates P value <0.05; the observed risk in the reclassified individuals is significantly different from the observed risk of the individuals in the grey cells.

7 efigure 4. Reclassification with CIMT, added to Framingham risk score in women. Figure with numbers of women with and without events (A) classified according to their 10year absolute risk to develop a myocardial infarction or stroke predicted with the Framingham risk score variables (rows) or classified according to their 10year absolute risk to develop a myocardial infarction or cerebrovascular event predicted with the Framingham risk score and a common CIMT measurement (columns). The observed Kaplan Meier absolute risk estimates (B) for all women (with and without events) are shown in the bottom table. *indicates P value <0.05; the observed risk in the reclassified individuals is significantly different from the observed risk of the individuals in the grey cells.

8 efigure 5. Reclassification after CIMT, added to Framingham risk score using 4 risk categories. Figure with numbers of individuals with and without events (A) classified according to their 10year absolute risk to develop a myocardial infarction or stroke predicted with the Framingham risk score variables (rows) or classified according to their 10year absolute risk to develop a myocardial infarction or cerebrovascular event predicted with the Framingham risk score and a common CIMT measurement (columns). The observed Kaplan Meier absolute risk estimates (B) for all individuals (with and without events) are shown in the bottom table. *indicates P value <0.05; the observed risk in the reclassified individuals is significantly different from the observed risk of the individuals in the grey cells.