[Early detection of atherosclerosis]

Within certain limits, it is not possible to screen for asymptomatic early atherosclerotic lesions with the aim of prevention. The effectiveness of different screening tests varies. A vascular murmur has little predictive value. Coronary or aorto-iliofemoral calcifications sometimes occur early. ECG or exertion thallium scan and low distal pressure at rest or during exercise can provide indirect clues as can continuous Doppler or the carotids or peripheral vessels. Pulsed Doppler and color-Doppler are the best screening tools for detecting wall thickening or a silent plaque. Arteriography is essential for patients with coronary artery disease and is often required for carotid or abdominal vessels, but is unfortunately an invasive method and underestimates lesions which do not give a defect image. Angioscopy and endoechography are difficult to manipulate and interpret and cannot be used in routine screening. No biological or genetic markers have been identified as formal indicators of atherosclerosis. Screening is justified in young patients at risk (high blood pressure, intensive smoking, major hyperlipidemia, diabetes, severe family history) because early lesions would lead to a more adapted treatment which can be expected to stabilize or even improve early lesions, or even reduce the risk of plaque rupture. In addition, carotid or iliofemoral lesions increase the risk of coronary artery disease.