Common carotid intima-media thickness does not add to Framingham risk score in individuals with diabetes mellitus: the USE-IMT initiative

H. M. den Ruijter, S. A. E. Peters, K. A. Groenewegen, T. J. Anderson, A. R. Britton, J. M. Dekker, G. Engstrom, M. J. Eijkemans, G. W. Evans, J. de Graaf, D. E. Grobbee, B. Hedblad, A. Hofman, S. Holewijn, A. Ikeda, M. Kavousi, K. Kitagawa, A. Kitamura, H. Koffijberg, M. A. IkramE. M. Lonn, M. W. Lorenz, E. B. Mathiesen, G. Nijpels, S. Okazaki, D. H. O'Leary, J. F. Polak, J. F. Price, C. Robertson, C. M. Rembold, M. Rosvall, T. Rundek, J. T. Salonen, M. Sitzer, C. D. A. Stehouwer, J. C. Witteman, K. G. Moons, M. L. Bots*

*Corresponding author for this work

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The aim of this work was to investigate whether measurement of the mean common carotid intima-media thickness (CIMT) improves cardiovascular risk prediction in individuals with diabetes. We performed a subanalysis among 4,220 individuals with diabetes in a large ongoing individual participant data meta-analysis involving 56,194 subjects from 17 population-based cohorts worldwide. We first refitted the risk factors of the Framingham heart risk score on the individuals without previous cardiovascular disease (baseline model) and then expanded this model with the mean common CIMT (CIMT model). The absolute 10 year risk for developing a myocardial infarction or stroke was estimated from both models. In individuals with diabetes we compared discrimination and calibration of the two models. Reclassification of individuals with diabetes was based on allocation to another cardiovascular risk category when mean common CIMT was added. During a median follow-up of 8.7 years, 684 first-time cardiovascular events occurred among the population with diabetes. The C statistic was 0.67 for the Framingham model and 0.68 for the CIMT model. The absolute 10 year risk for developing a myocardial infarction or stroke was 16% in both models. There was no net reclassification improvement with the addition of mean common CIMT (1.7%; 95% CI -1.8, 3.8). There were no differences in the results between men and women. There is no improvement in risk prediction in individuals with diabetes when measurement of the mean common CIMT is added to the Framingham risk score. Therefore, this measurement is not recommended for improving individual cardiovascular risk stratification in individuals with diabetes.
Original languageEnglish
Pages (from-to)1494-1502
Issue number7
Publication statusPublished - Jul 2013


  • Atherosclerosis
  • Cardiovascular disease
  • Carotid intima-media thickness
  • Diabetes
  • Prognosis
  • Risk prediction

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