Simonetto C, Heier M, Rospleszcz S, et al. - Given risk evaluation investigations on the influence of carotid intima-media thickness (CIMT) on cardiovascular events (CVEs) usually apply a linear association in Cox models of proportional hazards, however, CVEs are often caused by rupture of plaques driven by nonlinear mechanical properties of the arterial wall, therefore, researchers investigated whether the risk response is nonlinear as well and is detectable in CVE incidence data when related to CIMT as surrogate variable for atherosclerotic wall degeneration. They investigated the KORA F4 study involving 2,580 participants with CIMT measurements and 153 first CVEs, including 86 strokes and 67 myocardial infarctions. They employed linear and nonlinear models of both CIMT and dnCIMT, defined as deviation from gender and age-adjusted normal value, to determine the complex associations between age, CIMT and CVE risk. According to the findings, more accurate recognition of asymptomatic high-risk patients, specifically at a younger age, is enabled by the application of excess dnCIMT with nonlinear risk responses vs the standard approach of risk evaluation with linear models including CIMT.