Issue with models of integration : "The IMPROVE Study"

Epidemiological and clinical evidence indicates that < 50% of cardiovascular events are explained by vascular risk factors (VRFs), thus justifying for the need of alternative or integrated biomarkers to better stratify the patient risk. The intima-media thickness (IMT) of extracranial carotid arteries, measured by high-resolution B-mode ultrasound, is widely used to investigate the effects of conventional and non-conventional VRFs as well as the association with end-organ damage. In view of its correlation with coronary atherosclerosis, IMT has been proposed as an useful surrogate marker of atherosclerosis in carotid arteries and in other vascular regions. IMT is a good predictor of new myocardial infarction and it has been shown to be influenced by drugs known to reduce cardiovascular events, which supports the concept that IMT represents a biomarker of atherosclerosis. Carotid IMT alone has the same predictive capacity of VRFs. In a longitudinal - observational study, we have shown that the integrated use of VRFs included into the Framingham risk score and ultrasonic measurements of carotid IMT significantly increase their capacity to predict cardiovascular events in patients at low/intermediate risk. The integration of carotid IMT with non conventional VRFs (gene polymorphisms, oxidative burden, psyco or socioeconomic aspects etc.) may further optimize the stratification of patient risk. Another important carotid ultrasonic variable that may have predictive capacity, alone or when integrated with conventional or non conventional risk factors, is the progression of carotid IMT. A prospective, multicenter, longitudinal, long-term, observational study (The IMPROVE study) is currently ongoing. It aims to investigate the capacity of both cross sectional carotid IMT and overall IMT-progression to predict alone, or after integration with both conventional and non conventional VRF, the rate of new vascular events in an European population classified at high risk of cardiovascular disease for the presence of at least 3 VRFs. The patients’ enrolment ended in April 2005 and a total of 3711 patients were recruited in 6 European countries (1095 in Italy, 504 in France and 2140 in northern Europe). Funding: Research describing correlations between carotid and coronary atherosclerosis is supported by the Italian Ministry of Health. The improve study is supported by European Union (IMPROVE: QLG1-CT-2002-00896) References: 1. Measurement of carotid artery intima-media thickness in dyslipidemic patients increases the power of traditional risk factors to predict cardiovascular events. Baldassarre D, Amato M, Pustina L, Castelnuovo S, sancito S; Gerosa L; Veglia F, Keidar S, Tremoli E, Sirtori CR. Atherosclerosis. 2006 May 6; [Epub ahead of print]. 2. Carotid intima media thickness (IMT) and IMT-progression as predictors of vascular events in a high risk european population: “the IMPROVE study”. Tremoli E, Baldassarre D, on behalf of the “IMPROVE Study Group”. Atherosclerosis. 2006;7(3):42. 3. Baldassarre D, Amato M, Bondioli A, Sirtori CR, Tremoli E. Carotid artery intima-media thickness measured by ultrasonography in normal clinical practice correlates well with atherosclerosis risk factors. Stroke 2000;31:2426-2430. 4. Baldassarre D, Amato M, Pustina L, Tremoli E, Sirtori CR, Calabresi L, Franceschini G. Increased carotid artery intima-media thickness in subjects with primary hypoalphalipoproteinemia. Arterioscler Thromb Vasc Biol 2002;22:317-322.