Regular Mobile Phone Use and Incident Cardiovascular Diseases: is there an association with carotid intima-media thickness?
September 24, 2024
‘Zhang et al. published a study titled, “Regular Mobile Phone Use and Incident Cardiovascular Diseases: Mediating Effects of Sleep Patterns, Psychological Distress, and Neuroticism” [1]. The authors investigated the relationship between mobile phone use and incident cardiovascular disease (CVD) [1]. The primary outcome was incident CVD, one of the secondary outcomes was the carotid intima-media thickness (CIMT), a surrogate marker for pre-clinical atherosclerosis [1]. As to their results the authors wrote, “A total of 444,027 individuals from the UK Biobank without a history of CVD were included…Compared with nonregular mobile phone users, regular mobile phone users had a significantly higher risk of incident CVD (hazard ratio 1.04, 95% confidence interval 1.02-1.06) and increased CIMT (odds ratio 1.11, 95% CI 1.04-1.18)” [1]. As to the ultrasound cIMT measurements the authors cite the Coffey et al., 2017 paper, “Protocol and quality assurance for carotid imaging in 100,000 participants of UK Biobank: development and assessment” [2]. The cIMT measurement occurred at the far wall of the common carotid artery (CCA) [1,2]. With a one site cIMT measure the asymmetric presentation [3] of atherosclerotic is however neglected, risking misclassifying subjects as normal. It is therefore suggested to include different carotid artery (CA) segments for cIMT estimation. Bots and colleagues wrote, “The reproducibility of near wall CIMT measurements is similar to that reported for far wall CIMT measurements. …Combining information on near wall and far wall common CIMT into 1 IMT estimate (average of 4 sites) provided the strongest association with cardiovascular disease …” [4].The asymmetric nature of atherosclerosis [3] will more likely be captured by a composite measurement, providing a more just cIMT [4]. Zhang et al. [1] missed to discuss this critical methodological aspect and which might account for inaccurate estimations of atherosclerotic burden in the included subjects. In conclusion: Sonographic cIMT evaluation is a non-invasive, safe and cost-effective examination to evaluate early atherosclerotic burden. However, cIMT is a delicate surrogate marker, given that sub-millimetric differences suffice to classify subjects into different cIMT categories. In respect of the rigor of scientific reporting the pro and cons of each measurement protocol needs detailing to allow the reader for a balanced evaluation of the results. Considering these limitations, the cIMT results of the Zhang et al. study and the conclusion “Compared with nonregular mobile phone users, regular mobile phone users had a significantly higher risk of increased CIMT” [1] should be considered with due caution.’
https://onlinecjc.ca/article/S0828-282X(24)00979-6/abstract