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Subclinical arterial wall damage in patients at low to moderate cardiovascular risk
Insights
Subclinical atherosclerosis is common in individuals at low to moderate cardiovascular risk. Carotid plaques were the most frequent sign, highlighting the value of ultrasound in early detection and prevention.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Preventive Cardiology
Background:
- Cardiovascular disease (CVD) risk assessment often categorizes individuals into low, moderate, or high risk.
- Subclinical atherosclerosis, an early stage of CVD, may be present even in individuals with low to moderate estimated risk.
- Early detection of subclinical atherosclerosis is crucial for timely intervention and prevention of major cardiovascular events.
Purpose of the Study:
- To assess the prevalence of subclinical arterial wall damage in subjects at low and moderate cardiovascular risk using instrumental methods.
- To evaluate the utility of carotid duplex ultrasonography, including intima-media thickness (IMT) and carotid plaque (CP) assessment, in this population.
- To determine the association between different markers of subclinical atherosclerosis and cardiovascular risk stratification.
Main Methods:
- A cohort of 600 patients with a SCORE risk of 5% underwent carotid duplex ultrasonography to measure IMT and CP.
- Computer sphygmography was employed to assess ankle-brachial pulse wave velocity (abPWV) and ankle-brachial index (ABI).
- Data analysis focused on identifying the prevalence and interrelationships of these subclinical atherosclerosis markers.
Main Results:
- 64% of patients exhibited subclinical atherosclerosis signs, with carotid plaques (CPs) found in 60% and thickened intima-media thickness (IMT) in 5%.
- Increased abPWV was observed in 38% of patients, and an ABI < 0.9 in 5%.
- Carotid plaques were the most sensitive indicator (92% detection), often present even with normal IMT. CP detection increased significantly in men over 45 and women over 50.
Conclusions:
- Subclinical atherosclerosis is highly prevalent in individuals classified as low to moderate cardiovascular risk.
- Carotid plaques are a frequent finding and a sensitive marker for atherosclerosis in this population.
- Implementing carotid ultrasound in primary care could enhance cardiovascular risk stratification and facilitate early preventive strategies.
Aim:
The aim of this paper is to study the degree of subclinical arterial wall damage in subjects at low and moderate risk of cardiovascular death by the SCORE scale using instrumental research methods.
Methods:
We enrolled 600 patients (mean age 49.0 +/- 7.1 years, 74% women) with a calculated SCORE 5%, who passed a carotid duplex ultrasonography with a measurement of the intima-media thickness (IMT) and carotid plaque (CP) severity. In the study a computer sphygmography was also performed on the subjects to determine ankle-brachial pulse wave velocity (abPWV) and an ankle-brachial index (ABI).
Results:
We found 389 (64%) patients with subclinical signs of atherosclerosis. CPs were found in 359 patients (60%), thickened IMT in 28 patients (5%), increased abPWV in 227 patients (38%), and ABI of <0.9 in 29 patients (5%). In the patients with a thickened IMT only two had no CPs. In contrast, 92% of the patients with CPs had normal IMT. Increased abPWV was determined in 87% participants with CPs, and only in 30 subjects no CPs were found. All 29 patients with an ABI of less than 0.9 had CPs. The "presence of CP"was the most sensitive parameter in the patients included in the study, in terms of atherosclerosis determination (92%). The identification of individuals with CPs significantly increased in men over 45 years of age (in 68.4% of cases, P = 0.009), and in women over 50 (in 61.8% of cases, P = 0.001).
Conclusion:
Our data reinforces the importance of non-invasive imaging of atherosclerosis in subjects at low and moderate cardiovascular risk. The study demonstrated a high prevalence of subclinical atherosclerosis signs in patients at low to moderate risk by the SCORE scale and a high detection frequency of carotid plaques. This suggests that wider implementation of carotid ultrasound in primary care algorithms may improve risk stratification with timely initiation of preventive strategies.
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