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

Xin Wang; Geertje W. Dalmeijer; Hester M. den Ruijter; Todd J. Anderson; Annie R. Britton; Jacqueline Dekker; Gunnar Engstrom; Greg W. Evans; Jacqueline de Graaf; Diederick E. Grobbee; Bo Hedblad; Suzanne Holewijn; Ai Ikeda; Jussi Kauhanen; Kazuo Kitagawa; Akihiko Kitamura; Sudhir Kurl; Eva M. Lonn; Matthias W. Lorenz; Ellisiv B. Mathiesen; Giel Nijpels; Shuhei Okazaki; Joseph F. Polak; Jacqueline F. Price; Christopher M. Rembold; Maria Rosvall; Tatjana Rundek; Jukka T. Salonen; Matthias Sitzer; Coen D. A. Stehouwer; Tomi-Pekka Tuomainen; Sanne A. E. Peters; Michiel L. Bots

doi:10.1371/journal.pone.0173393

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

Xin Wang, Geertje W. Dalmeijer^*, Hester M. den Ruijter, Todd J. Anderson, Annie R. Britton, Jacqueline Dekker, Gunnar Engstrom, Greg W. Evans, Jacqueline de Graaf, Diederick E. Grobbee, Bo Hedblad, Suzanne Holewijn, Ai Ikeda, Jussi Kauhanen, Kazuo Kitagawa, Akihiko Kitamura, Sudhir Kurl, Eva M. Lonn, Matthias W. Lorenz, Ellisiv B. MathiesenGiel Nijpels, Shuhei Okazaki, Joseph F. Polak, Jacqueline F. Price, Christopher M. Rembold, Maria Rosvall, Tatjana Rundek, Jukka T. Salonen, Matthias Sitzer, Coen D. A. Stehouwer, Tomi-Pekka Tuomainen, Sanne A. E. Peters, Michiel L. Bots

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Article number	0173393
Number of pages	10
Journal	PLOS ONE
Volume	12
Issue number	3
DOIs	https://doi.org/10.1371/journal.pone.0173393
Publication status	Published - 21 Mar 2017

Keywords

SUBCLINICAL ATHEROSCLEROSIS
GENERAL-POPULATION
CLINICAL-PRACTICE
MALMO DIET
PROGRESSION
ARTERY
PREDICTION
ROTTERDAM
DISEASE
EVENTS

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10.1371/journal.pone.0173393Licence: CC BY

Cite this

Wang, X., Dalmeijer, G. W., den Ruijter, H. M., Anderson, T. J., Britton, A. R., Dekker, J., Engstrom, G., Evans, G. W., de Graaf, J., Grobbee, D. E., Hedblad, B., Holewijn, S., Ikeda, A., Kauhanen, J., Kitagawa, K., Kitamura, A., Kurl, S., Lonn, E. M., Lorenz, M. W., ... Bots, M. L. (2017). Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study. PLOS ONE, 12(3), Article 0173393. https://doi.org/10.1371/journal.pone.0173393

@article{e6d5cf76669d4848a6aefbfa10664466,

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

abstract = "BackgroundThe 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.MethodsIndividual 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.ResultsCompared 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.ConclusionClusters 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.",

keywords = "SUBCLINICAL ATHEROSCLEROSIS, GENERAL-POPULATION, CLINICAL-PRACTICE, MALMO DIET, PROGRESSION, ARTERY, PREDICTION, ROTTERDAM, DISEASE, EVENTS",

author = "Xin Wang and Dalmeijer, {Geertje W.} and {den Ruijter}, {Hester M.} and Anderson, {Todd J.} and Britton, {Annie R.} and Jacqueline Dekker and Gunnar Engstrom and Evans, {Greg W.} and {de Graaf}, Jacqueline and Grobbee, {Diederick E.} and Bo Hedblad and Suzanne Holewijn and Ai Ikeda and Jussi Kauhanen and Kazuo Kitagawa and Akihiko Kitamura and Sudhir Kurl and Lonn, {Eva M.} and Lorenz, {Matthias W.} and Mathiesen, {Ellisiv B.} and Giel Nijpels and Shuhei Okazaki and Polak, {Joseph F.} and Price, {Jacqueline F.} and Rembold, {Christopher M.} and Maria Rosvall and Tatjana Rundek and Salonen, {Jukka T.} and Matthias Sitzer and Stehouwer, {Coen D. A.} and Tomi-Pekka Tuomainen and Peters, {Sanne A. E.} and Bots, {Michiel L.}",

year = "2017",

month = mar,

day = "21",

doi = "10.1371/journal.pone.0173393",

language = "English",

volume = "12",

journal = "PLOS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "3",

}

Wang, X, Dalmeijer, GW, den Ruijter, HM, Anderson, TJ, Britton, AR, Dekker, J, Engstrom, G, Evans, GW, de Graaf, J, Grobbee, DE, Hedblad, B, Holewijn, S, Ikeda, A, Kauhanen, J, Kitagawa, K, Kitamura, A, Kurl, S, Lonn, EM, Lorenz, MW, Mathiesen, EB, Nijpels, G, Okazaki, S, Polak, JF, Price, JF, Rembold, CM, Rosvall, M, Rundek, T, Salonen, JT, Sitzer, M, Stehouwer, CDA, Tuomainen, T-P, Peters, SAE & Bots, ML 2017, 'Clustering of cardiovascular risk factors and carotid intima-media thickness: The USE-IMT study', PLOS ONE, vol. 12, no. 3, 0173393. https://doi.org/10.1371/journal.pone.0173393

TY - JOUR

T1 - Clustering of cardiovascular risk factors and carotid intima-media thickness

T2 - The USE-IMT study

AU - Wang, Xin

AU - Dalmeijer, Geertje W.

AU - den Ruijter, Hester M.

AU - Anderson, Todd J.

AU - Britton, Annie R.

AU - Dekker, Jacqueline

AU - Engstrom, Gunnar

AU - Evans, Greg W.

AU - de Graaf, Jacqueline

AU - Grobbee, Diederick E.

AU - Hedblad, Bo

AU - Holewijn, Suzanne

AU - Ikeda, Ai

AU - Kauhanen, Jussi

AU - Kitagawa, Kazuo

AU - Kitamura, Akihiko

AU - Kurl, Sudhir

AU - Lonn, Eva M.

AU - Lorenz, Matthias W.

AU - Mathiesen, Ellisiv B.

AU - Nijpels, Giel

AU - Okazaki, Shuhei

AU - Polak, Joseph F.

AU - Price, Jacqueline F.

AU - Rembold, Christopher M.

AU - Rosvall, Maria

AU - Rundek, Tatjana

AU - Salonen, Jukka T.

AU - Sitzer, Matthias

AU - Stehouwer, Coen D. A.

AU - Tuomainen, Tomi-Pekka

AU - Peters, Sanne A. E.

AU - Bots, Michiel L.

PY - 2017/3/21

Y1 - 2017/3/21

N2 - BackgroundThe 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.MethodsIndividual 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.ResultsCompared 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.ConclusionClusters 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.

AB - BackgroundThe 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.MethodsIndividual 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.ResultsCompared 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.ConclusionClusters 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.

KW - SUBCLINICAL ATHEROSCLEROSIS

KW - GENERAL-POPULATION

KW - CLINICAL-PRACTICE

KW - MALMO DIET

KW - PROGRESSION

KW - ARTERY

KW - PREDICTION

KW - ROTTERDAM

KW - DISEASE

KW - EVENTS

U2 - 10.1371/journal.pone.0173393

DO - 10.1371/journal.pone.0173393

M3 - Article

C2 - 28323823

SN - 1932-6203

VL - 12

JO - PLOS ONE

JF - PLOS ONE

IS - 3

M1 - 0173393

ER -