Concordance and prevalence of subclinical atherosclerosis in different vascular territories

Subclinical atherosclerosis (SA) in the carotid, femoral, and coronary territories is a powerful predictor of cardiovascular (CV) events. Whether it is sufficient to assess SA in a single vascular territory in early-stage disease is uncertain. We aimed to determine the prevalence and concordance of SA in these vascular beds in asymptomatic patients without known CV disease.

We enrolled patients aged 35 to 75 years who were asymptomatic, without known CV disease, and had undergone carotid and femoral Doppler ultrasonography and calcium scoring. Those receiving statins were excluded. SA was defined as the presence of plaques in the carotid and/or femoral arteries or the presence of calcium in the coronary arteries (Agatston score >0).

A total of 212 patients were identified with a mean age of 53 ± 7 years, of which 60% (128 patients) were men. The prevalence of SA was 62%. The distribution of SA between the three territories was similar, involving the carotid territory in 38% of cases, the femoral in 31%, and the coronaries in 37%. The concordance between the different vascular territories was weak, with a k index of 0.21 between the coronary and carotid territories, 0.27 between the coronary and femoral territories, and 0.34 between the carotid and femoral territories.

The prevalence of SA in asymptomatic patients without known CV disease is high. The concordance in the presence of SA between the three vascular territories is weak. Therefore, all three vascular beds need to be investigated.