Cardiovascular Disease Risk Prediction Measures

To the Editor: Dr Den Ruijter and colleagues¹ for the USE-Intima-Media Thickness (USE-IMT) project presented a meta-analysis of participant level data on common carotid artery intima-media thickness (CIMT) measurements in cardiovascular disease risk prediction. The article, however, included a potentially misleading statement that warrants clarification and raises additional questions.

In their article, the authors stated that clinical use of common CIMT measurements has been recommended, and they referenced the 2008 American Society of Echocardiography (ASE) consensus statement.² However, that consensus statement did not recommend using common CIMT measurement as an isolated ultrasound predictor of cardiovascular disease risk because common CIMT measurements are not as sensitive to the severity of subclinical arterial injury as bifurcation, internal CIMT measurement, or the presence of carotid plaques. The ASE consensus statement required that a circumferential plaque scan be performed in addition to measuring common CIMT.² Also, for the purposes of risk prediction, the ASE consensus statement only considered common CIMT measurements in the highest quartile as indicative of increased cardiovascular disease risk.² The risk estimates associated with high common CIMT measurements are very different than those associated with continuous common CIMT measurements, as presented in the USE-IMT article.¹