Should preclinical vascular abnormalities be measured in asymptomatic adults to improve cardiovascular risk...

Area of Science:

• Cardiology
• Diagnostic Testing
• Preventive Medicine

Background:

• Conflicting guidelines exist on the utility of noninvasive tests for asymptomatic adults with intermediate cardiovascular risk.
• Reclassification of risk is a recent criterion for evaluating diagnostic test utility.
• This review assesses limitations in reclassification and the clinical utility of specific noninvasive tests.

Purpose of the Study:

• To examine limitations in risk reclassification by noninvasive tests.
• To evaluate the clinical utility of carotid ultrasound, pulse wave velocity, and ankle-brachial index.
• To provide a clinical perspective on the use of these diagnostic tools.

Main Methods:

• Review of existing literature and guideline recommendations.
• Analysis of the concept of risk reclassification in diagnostic testing.
• Clinical evaluation of carotid ultrasound, pulse wave velocity, and ankle-brachial index.

Main Results:

• Risk reclassification is less impactful than presumed, as many intermediate-risk patients already warrant therapy.
• Withholding treatment based on downgraded risk is uncertain, and intensified therapy offers marginal additional benefit.
• Noninvasive tests require improved reproducibility, standardization, and reference values for clinical integration.

Conclusions:

• Routine screening for all intermediate-risk individuals is not generally justified.
• Screening should target individuals where noninvasive tests alter clinical management, such as those with LDL < 2.5 mmol/L who may initiate statin therapy.
• The primary value of these tests lies in identifying preclinical disease rather than solely determining risk.