Journal
DIABETES CARE
Volume 38, Issue 10, Pages 1921-1929Publisher
AMER DIABETES ASSOC
DOI: 10.2337/dc14-2732
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Funding
- NHLBI
- Pustertaler Verein zur Praevention von Herz- und Hirngefaesserkrankungen, Gesundheitsbezirk Bruneck
- Assessorat fuer Gesundheit, Province of Bolzano, Italy
- Stiftung Deutsche Schlaganfall-Hilfe
- NHLBI [N01-HC-85079, N01-HC-85086, N01-HC-35129, N01-HC-15103, N01-HC-55222, U01-HL-080295]
- National Institute of Neurological Disorders and Stroke (NINDS)
- NINDS [R37-NS-029993]
- National Institute of Dental and Craniofacial Research [R01-DE-13094]
- AOK Bayern
- Netherlands Foundation for Scientific Research (NWO), ZonMw [Vici 918-76-619]
- Deutsche Forschungsgemeinschaft (DFG) [Lo 1569/2-1, Lo 1569/2-3]
- MRC [MR/L003120/1] Funding Source: UKRI
- British Heart Foundation [RG/08/014/24067] Funding Source: researchfish
- Medical Research Council [MR/L003120/1] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0512-10165] Funding Source: researchfish
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OBJECTIVECarotid intima-media thickness (CIMT) is a marker of subclinical organ damage and predicts cardiovascular disease (CVD) events in the general population. It has also been associated with vascular risk in people with diabetes. However, the association of CIMT change in repeated examinations with subsequent CVD events is uncertain, and its use as a surrogate end point in clinical trials is controversial. We aimed at determining the relation of CIMT change to CVD events in people with diabetes.RESEARCH DESIGN AND METHODSIn a comprehensive meta-analysis of individual participant data, we collated data from 3,902 adults (age 33-92 years) with type 2 diabetes from 21 population-based cohorts. We calculated the hazard ratio (HR) per standard deviation (SD) difference in mean common carotid artery intima-media thickness (CCA-IMT) or in CCA-IMT progression, both calculated from two examinations on average 3.6 years apart, for each cohort, and combined the estimates with random-effects meta-analysis.RESULTSAverage mean CCA-IMT ranged from 0.72 to 0.97 mm across cohorts in people with diabetes. The HR of CVD events was 1.22 (95% CI 1.12-1.33) per SD difference in mean CCA-IMT, after adjustment for age, sex, and cardiometabolic risk factors. Average mean CCA-IMT progression in people with diabetes ranged between -0.09 and 0.04 mm/year. The HR per SD difference in mean CCA-IMT progression was 0.99 (0.91-1.08).CONCLUSIONSDespite reproducing the association between CIMT level and vascular risk in subjects with diabetes, we did not find an association between CIMT change and vascular risk. These results do not support the use of CIMT progression as a surrogate end point in clinical trials in people with diabetes.
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