Repeat cIMT measurement for predicting cardiovascular events

Project title Large-scale evaluation of repeat measurements of carotid intima-media thickness for cardiovascular disease prediction Content of research project Atherosclerosis is a potentially serious condition where blood vessels become blocked by fatty depositions called plaques, eventually causing life-threatening diseases such as heart attacks and strokes. Even before atherosclerosis causes any symptoms, when people may be unaware of their condition, atherosclerosis can be detected by special medical tests such as carotid intima-media thickness measurement with ultrasound of the neck arteries. In the proposed project, my team will work together with around 62 studies that have measured carotid intima-media thickness in about 78,000 individuals. We will combine their study data in a big database at the Medical University of Innsbruck. Hypotheses We will analyse data of the Prospective Studies of Atherosclerosis (Proof- ATHERO) consortium to answer a range of questions that are directly relevant to patients and the general community. We will be able to provide guidance on how carotid intima-media thickness should best be measured in clinical practice and whether a single cut-off value for carotid intima-media thickness is sufficient to reliably identify people at high cardiovascular risk or whether a more graded approach with different risk categories is preferred. Moreover, we will be able to determine whether a slower progression of carotid intima-media thickness over time can be used as an indicator that a medication can effectively prevent cardiovascular events. Finally, we will be able to test whether repeated carotid intima-media thickness measurements in people can help improve cardiovascular risk prediction and thereby target preventive interventions. Methods We will work as an interdisciplinary team of researchers from various backgrounds, including epidemiologists, statistics, mathematics, and medicine. We will use a sophisticated system for handling the data of so many studies. Novelty of this project This project will be unique because it is the largest in size worldwide, collects very detailed information, and is done in collaboration with many institutions around the globe. The project will help to establish one of the leading centres of atherosclerosis research in Austria.

In this funded project, the research team from the Medical University of Innsbruck investigated whether the wall thickness of the carotid artery, a blood vessel that supplies the brain with blood, is associated with the risk of developing cardiovascular disease in the future. To this end, the research team collaborated with scientific institutions from 25 countries and 40 cities worldwide and was thus able to collate, harmonise and jointly statistically analyse the original data from 74 international studies. To measure the thickness of the vessel wall, the participating studies used special techniques such as high-resolution ultrasound in order to quantify the so-called intima-media thickness. The researchers' statistical analyses showed that a higher intima-media thickness was associated with increased risk of developing atherosclerotic plaque. Moreover, the researchers were able to show that measuring intima-media thickness can be helpful in assessing whether and to what extent new drugs are able to reduce the risk of cardiovascular disease, and thus to conduct future clinical trials more efficiently. Furthermore, the team showed that, contrary to the current recommendations of medical societies, prediction of cardiovascular disease was best when the intima-media thickness was measured at both the anterior and posterior wall of the carotid artery. The project findings were published in six scientific papers and were presented in 13 lectures at various conferences in Europe and the United States. The project was awarded the Dr Otto Seibert Prize (2021), the Best Paper Award of the Austrian Atherosclerosis Society (2021) and the Paul Dudley White International Scholar Award of the American Heart Association (2023), among others.