Does detection of carotid plaque affect physician behavior or motivate patients?

Imaging techniques to identify subclinical atherosclerosis are becoming more widespread, but few data exist regarding their influence on patient or physician behavior. We evaluated the impact of ultrasound screening to identify carotid artery plaques on physician treatment plans and patient motivation.

Subjects included asymptomatic patients without known vascular disease who had 2 or more cardiac risk factors. Circumferential scanning of the right and left carotid arteries to identify carotid plaques was performed using a handheld ultrasound device in an office setting. The physician's initial treatment recommendations were assessed before and after the results of the carotid scan were reported. Subjects completed a survey to assess motivation to make lifestyle changes before and after the results of the scan were provided.

Fifty subjects were enrolled over 9 months. Their mean (SD) age was 54.0 (10.4) years and their mean Framingham 10-year cardiovascular risk was 7.8% (7.9%). More than half (58%) of the subjects had at least one carotid plaque. When carotid plaque was identified, physicians were more likely to prescribe aspirin (P = .031) and lipid-lowering therapy (P = .004). Although subjects with carotid plaque reported an increase in their perceived likelihood of developing heart disease (P = .013), they did not report increased motivation to make lifestyle changes.

Ultrasound screening for carotid plaque in an office setting can alter physician treatment plans. Although the presence of plaque increased patient perception of cardiovascular risk, it did not motivate patients to make lifestyle changes.