Open Access

Martin Bahls, Matthias W Lorenz, Marcus Dörr, 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 Schminke, Damiano Baldassarre, Fabrizio Veglia, Oscar H Franco, Maryam Kavousi, Eric de Groot, Ellisiv B Mathiesen, Liliana Grigore, Joseph F Polak, Tatjana Rundek, Coen DA Stehouwer, Michael R Skilton, Apostolos I 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, Göran Bergström, Jussi Kauhanen, Stefan Kiechl, Matthias Sitzer, Horst Bickel, Ralph L Sacco, Albert Hofman, Henry Völzke, Simon G Thompson

• 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.