Use of carotid intima-media thickness and vascular age to modify cardiovascular risk prediction
Adam D Gepner1, Jon G Keevil, Rachael A Wyman
1University of Wisconsin Atherosclerosis Imaging Research Program, Division of Cardiovascular Medicine, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA.
Insights
Carotid artery intima-media thickness (CIMT) measurement and vascular age can identify advanced atherosclerosis, significantly altering cardiovascular disease (CVD) risk assessment in asymptomatic patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Preventive Cardiology
Background:
- Cardiovascular disease (CVD) risk assessment is crucial for preventive strategies.
- Accurate identification of subclinical atherosclerosis aids in refining risk stratification.
- Carotid artery intima-media thickness (CIMT) is a marker of subclinical atherosclerosis.
Purpose of the Study:
- To identify predictors for whom CIMT measurement and vascular age determination can alter CVD risk assessment.
- To evaluate the impact of CIMT and vascular age on modifying existing CVD risk estimates.
Main Methods:
- Study included asymptomatic, nondiabetic patients referred for CIMT ultrasound.
- Advanced subclinical atherosclerosis defined as CIMT at or above the 75th percentile for age, sex, and race.
- CIMT values were used to calculate vascular age and modify Framingham 10-year CVD risk.
Main Results:
- 51.6% of patients were not on lipid-lowering therapy.
- 30% of patients had advanced subclinical atherosclerosis.
- 23.8% of patients experienced a CVD risk change of 5% or more, predicted by systolic blood pressure, total/HDL cholesterol ratio, and male sex.
Conclusions:
- CIMT measurement and vascular age determination effectively identify individuals with advanced subclinical atherosclerosis.
- These assessments lead to clinically significant changes in CVD risk stratification.
- This approach enhances personalized CVD prevention strategies.
Background:
This study identified predictors of patients for whom carotid artery intima-media thickness (CIMT) measurement and determination of vascular age could change cardiovascular disease (CVD) risk assessment.
Methods:
We studied consecutive patients who were asymptomatic and nondiabetic, referred for ultrasound measurement of CIMT. Individuals with CIMT 75th percentile or greater for age, sex, and race were defined as having advanced subclinical atherosclerosis. CIMT values were converted to vascular age estimates and were used to modify Framingham 10-year CVD risk estimates.
Results:
Of 506 patients, 261 (51.6%) were not taking lipid-lowering therapy. Advanced subclinical atherosclerosis was present in 77 (30%). There were 62 patients (23.8%) with a change in CVD risk of 5% or more. Predictors of 5% or more change in CVD risk were systolic blood pressure (P < .001), total/high-density lipoprotein cholesterol ratio (P < .001), and male sex (P < .001). Of the 97 patients at moderate or moderately high risk, 56.7% changed risk classification.
Conclusions:
Measurement of CIMT and determination of vascular age can identify individuals with advanced subclinical atherosclerosis, resulting in clinically meaningful alterations in CVD risk estimates.
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