Multiple risk factors predict carotid intima media thickness in a 10 year prospective study

Carotid intima‒media thickness (CIMT) is an early marker of atherosclerosis, and identifying its risk factors is crucial for prevention. This study aimed to explore the risk factors for CIMT, develop a risk prediction model, evaluate its predictive performance, and propose prevention strategies. A prospective cohort was established using health check-up data from the Health Management Center of the Third Xiangya Hospital, Central South University. Participants with physiological CIMT values at baseline and complete clinical data were followed from 2012 to 2023, with at least two examinations recorded. Nonlinear relationships were analyzed via restricted cubic splines, whereas CIMT risk was assessed via Kaplan‒Meier curves. Independent risk factors were identified via Cox regression models and incorporated into a risk prediction model. Among 19,212 participants (64.6% males, 35.4% females), 2,087 developed CIMT, with 1,633 showing an increase of more than 0.2 mm. Multivariate Cox regression identified age (> 40 years), LDL upper tertile, hypertension, impaired fasting glucose, and current smoking as independent risk factors, whereas HDL upper tertile and sleep duration over seven hours were protective factors. The prediction model demonstrated good performance, with AUC values of 0.714, 0.717, and 0.757 at 3, 5, and 8 years, respectively. These findings can be used to enhance CIMT risk assessment and may aid in early prevention strategies.