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Detection of presymptomatic atherosclerosis: a current perspective
1Department of Cardiology, Royal Prince Alfred Hospital, and the Heart Research Institute, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
Insights
Detecting early atherosclerosis, a key cause of heart attack and stroke, is crucial for prevention. Promising new imaging and serum marker techniques help identify at-risk individuals before symptoms appear.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Biomarkers
Background:
- Atherosclerosis is a leading cause of death globally, driving myocardial infarction and stroke.
- Early detection of atherosclerosis is vital for developing effective prevention strategies and reducing mortality.
- Understanding early pathophysiology enables the development of novel diagnostic methods.
Purpose of the Study:
- To review promising techniques for detecting early, presymptomatic atherosclerosis.
- To highlight methods for assessing both structural and functional changes in early atherosclerosis.
- To identify individuals at highest cardiovascular risk.
Main Methods:
- Electron-beam computed tomography (EBCT) and magnetic resonance imaging (MRI) for coronary artery structural changes.
- External vascular ultrasound for surrogate markers (e.g., carotid intima-media thickness).
- Non-invasive ultrasound for endothelial dysfunction assessment and analysis of serum markers.
Main Results:
- Structural assessment techniques like EBCT and MRI can visualize early arterial changes.
- Functional assessment, particularly endothelial dysfunction via ultrasound, detects changes preceding structural alterations.
- Various serum markers show potential utility in identifying atherosclerosis.
Conclusions:
- Multiple advanced techniques offer potential for early, presymptomatic detection of atherosclerosis.
- Combining structural and functional assessments may improve cardiovascular risk stratification.
- Further research into these promising methods can enhance preventative strategies against atherosclerosis-related diseases.
Abstract:
Atherosclerosis, the pathological process underlying myocardial infarction, stroke and other occlusive vascular disease, is the major cause of death in the Western world. The development of techniques to accurately and reproducibly detect and measure the early changes of atherosclerosis and/or to identify subjects at highest cardiovascular risk may aid in the development of prevention strategies and facilitate a decrease in morbidity and mortality from atherosclerosis. Increasing understanding of the pathophysiology of early atherosclerosis has allowed the development of a number of potential methods for the assessment of the early stages of atherosclerosis in humans. These include techniques for assessing early structural changes in the coronary arteries with electron-beam computed tomography and magnetic resonance imaging. External vascular ultrasound has also been used to image other circulations as a surrogate marker for coronary atherosclerosis, e.g. the measurement of carotid artery intima-media thickness. Early functional changes of atherosclerosis have also been described many years before the development of structural changes. A number of techniques have been developed to measure endothelial dysfunction, one of the earliest changes of atherosclerosis, including non-invasive measurement of endothelial function using external vascular ultrasound. A variety of serum markers have also been described, and may be useful markers of atherosclerosis. We discuss some of the more promising techniques for the detection of early, presymptomatic atherosclerosis.