Is intima-media thickness a predictor for cardiovascular ...

Correspondence

Department of Dermatology (AG-C, AIS-M, CP-H) and Department of Cardiology (LR-P), Complejo Hospitalario Toledo, Toledo, Spain; Department of Dermatology, Hospital Virgen del Valle, Toledo 45071, Spain (AG-C); Department of Radiology, Gregorio Mara?on Hospital, Madrid, Spain (JG-C); and Department of Gastroenterology, Hospital Cl?nico de Granada, Granada, Spain (JLG-C)

1 N?slund U, Ng N, Lundgren A, et al. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. Lancet 2019; 393: 133?142.

2 Spence JD. Carotid ultrasound phenotypes are biologically distinct. Arterioscler Thromb Vasc Biol 2015; 35: 1910?13.

3 Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: 2935?59.

4 Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016; 37: 2315?81.

5 Laclaustra M, Casasnovas JA, Fern?ndez-Ortiz A, et al. Femoral and carotid subclinical atherosclerosis association with risk factors and coronary calcium: the AWHS study. J Am Coll Cardiol 2016; 67: 1263?74.

6 Gonzalez-Cantero A, Gonzalez-Cantero J, Sanchez-Moya AI, et al. Femoral artery ultrasound for improving the detection of atherosclerosis in psoriasis. J Am Acad Dermatol 2018; 80: 784?86.

7 Dalager S, Falk E, Kristensen IB, Paaske WP. Plaque in superficial femoral arteries indicates generalized atherosclerosis and vulnerability to coronary death: an autopsy study. J Vasc Surg 2008; 47: 296?302.

Authors' reply

We thank Alvaro Gonzalez-Cantero and colleagues for raising interesting questions regarding intima-media thickness as a predictor of cardiovascular disease.

We reported the effect on primary prevention, as measured by the Framingham Risk Score and Systematic Coronary Risk Evaluation, of pictorial information about asymptomatic atherosclerosis compared with traditional risk factor-based risk communication alone.1 This approach to informing cardiovascular disease risk comprised pictorial information about early atherosclerotic disease, instead of conventional abstract information about indirect risk factors of cardiovascular disease. We did not evaluate the predictive value of carotid intima-media thickness on cardiovascular disease outcomes.

As Gonzalez-Cantero and colleagues point out, intima-media thickness is not recommended by American Heart Association and European guidelines for the clinical evaluation of cardiovascular disease risk, largely owing to conflicting results and a lack of standardisation in the assessment models.2 According to the American Heart Association evidence statement,3 more research is needed regarding carotid intima-media thickness as a marker of subclinical atherosclerosis and on the optimisation of information about cardiovascular disease risk in asymptomatic individ uals. Accordingly, several carotid intima-media thickness measurements as well as plaque were related to established cardiovascular risk factors4 and carotid intima-media thickness was used as a marker of atherosclerosis to monitor disease progression5,6 or for the evaluation of treatment effects.7

We agree that the debate concerning use of carotid intima-media thickness as a marker for cardiovascular disease risk is not finalised. We hope that our work can make useful contributions to this topic. Since VIPVIZA is a longi tudinal trial that measures several phenotypes of carotid intima-media thickness in subjects with subclinical atherosclerosis, it has the potential to contribute to the understanding of early atherosclerosis development. Once data on clinical cardiovascular endpoints are collected 5?10 years after baseline, VIPVIZA will also contribute to the evaluation of both carotid intima-media thickness and plaque as predictors of cardiovascular disease.

We agree that the femoral approach is interesting for studies of cardiovascular disease risk prediction. However, it could be questioned whether crosssectional results on associations between carotid and femoral plaque and the intermediate cardiovascular risk marker coronary calcium score or links between femoral plaque and atherosclerosis in psoriasis patients are valid to establish the predictive value of carotid and femoral plaque on atherosclerotic cardiovascular disease

overall. To the best of our knowledge the role of femoral plaque for the clinical prediction of cardiovascular disease is not fully established. This might explain why femoral plaque is not mentioned in the clinical guidelines.

Hopefully our results can inspire further research on pictorial risk infor mation aimed at optimised cardio vascular disease prevention.

*Ulf N?slund, Anna Lundgren, Davide Vanoli, Margareta Norberg

ulf.naslund@umu.se

Department of Public Health and Clinical Medicine, Ume? University, Ume? 901 87, Sweden

1 N?slund U, Ng N, Lundgren A, et al. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. Lancet 2019; 393: 133?42.

2 Naqvi TZ, Lee MS. Carotid intima-media thickness and plaque in cardiovascular risk assessment. JACC Cardiovasc Imaging 2014; 7: 1025?38.

3 Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: 2935?59.

4 Khanna NN, Jamthikar AD, Araki T, et al. Nonlinear model for the carotid artery disease 10-year risk prediction by fusing conventional cardiovascular factors to carotid ultrasound image phenotypes: a Japanese diabetes cohort study. Echocardiography 2019; 36: 345?61.

5 Cardoso CRL, Salles GC, Leite NC, Salles GF. Prognostic impact of carotid intima-media thickness and carotid plaques on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study. Cardiovasc Diabetol 2019; 18: 2.

6 Wu GC, Liu HR, Leng RX, et al. Subclinical atherosclerosis in patients with systemic lupus erythematosus: a systemic review and meta-analysis. Autoimmun Rev 2016; 15: 22?37.

7 Burggraaf B, van Breukelen-van der Stoep DF, de Vries MA, et al. Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial. Ann Rheum Dis 2019; 78: 335?41.

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