Progression of conventional cardiovascular risk factors and vascular disease risk in individuals: insights from the PROG-IMT consortium

Martin Bahls*, Matthias W. Lorenz, Marcus Doerr, Lu Gao, Kazuo Kitagawa, Tomi-Pekka Tuomainen, Stefan Agewall, Gerald Berenson, Alberico L. Catapano, Giuseppe D. Norata, Michiel L. Bots, Wiek van Gilst, Folkert W. Asselbergs, Frank P. Brouwers, Heiko Uthoff, Dirk Sander, Holger Poppert, Michael Hecht Olsen, Jean Philippe Empana, Ulf SchminkeDamiano Baldassarre, Fabrizio Veglia, Oscar H. Franco, Maryam Kavousi, Eric de Groot, Ellisiv B. Mathiesen, Liliana Grigore, Joseph F. Polak, Tatjana Rundek, Coen D. A. Stehouwer, Michael R. Skilton, Apostolos Hatzitolios, Christos Savopoulos, George Ntaios, Matthieu Plichart, Stela McLachlan, Lars Lind, Peter Willeit, Helmuth Steinmetz, Moise Desvarieux, M. Arfan Ikram, Stein Harald Johnsen, Caroline Schmidt, Johann Willeit, Pierre Ducimetiere, Jackie F. Price, Goran Bergstrom, Jussi Kauhanen, Stefan Kiechl, Matthias Sitzer, PROG-IMT Study Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aims Averaged measurements, but not the progression based on multiple assessments of carotid intima-media thickness, (cIMT) are predictive of cardiovascular disease (CVD) events in individuals. Whether this is true for conventional risk factors is unclear.

Methods and results An individual participant meta-analysis was used to associate the annualised progression of systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol with future cardiovascular disease risk in 13 prospective cohort studies of the PROG-IMT collaboration (n = 34,072). Follow-up data included information on a combined cardiovascular disease endpoint of myocardial infarction, stroke, or vascular death. In secondary analyses, annualised progression was replaced with average. Log hazard ratios per standard deviation difference were pooled across studies by a random effects meta-analysis. In primary analysis, the annualised progression of total cholesterol was marginally related to a higher cardiovascular disease risk (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.00 to 1.07). The annualised progression of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol was not associated with future cardiovascular disease risk. In secondary analysis, average systolic blood pressure (HR 1.20 95% CI 1.11 to 1.29) and low-density lipoprotein cholesterol (HR 1.09, 95% CI 1.02 to 1.16) were related to a greater, while high-density lipoprotein cholesterol (HR 0.92, 95% CI 0.88 to 0.97) was related to a lower risk of future cardiovascular disease events.

Conclusion Averaged measurements of systolic blood pressure, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol displayed significant linear relationships with the risk of future cardiovascular disease events. However, there was no clear association between the annualised progression of these conventional risk factors in individuals with the risk of future clinical endpoints.

Original languageEnglish
Article number2047487319877078
Pages (from-to)234-243
Number of pages10
JournalEuropean Journal of Preventive Cardiology
Issue number3
Early online date16 Oct 2019
Publication statusPublished - Feb 2020


  • Risk factors
  • CVD biomarker
  • risk factor progression

Cite this