Original article
The Role of Carotid Ultrasound in Assessing Carotid Atherosclerosis in Individuals at Low-to-intermediate Cardiovascular RiskPapel de la ecografía carotídea en la reclasificación del riesgo cardiovascular de sujetos de riesgo bajo–intermedio

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Abstract

Introduction and objectives

Detection of carotid atherosclerosis might help to better identify individuals susceptible to cardiovascular events. We aimed to quantify the number of participants with carotid atherosclerosis and low-to-intermediate cardiovascular risk according to the traditional risk factor scoring, and therefore with an elevated risk of cardiovascular events.

Methods

Cross-sectional, observational study performed during a cardiovascular screening program. From a total of 3778 volunteers, low-to-intermediate cardiovascular risk individuals (N=2354) were identified and studied. Physical examination, blood test, and carotid ultrasound followed standard procedures. Common, bulb, and internal carotid arteries were examined and common carotid intima-media thickness was measured. SCORE risk value was calculated for all participants. Univariate and multivariate statistical analysis was performed.

Results

Mean age of participants was 58.9 (15) years, 43.8% were men, 23.7% had hypertension, and 20.5% had hypercholesterolemia. The mean SCORE value was 1.47 (1.4). Both carotid intima-media thickness and the prevalence of carotid plaques increased steadily and significantly (P<.005) as advanced decades of life were analyzed. Variables significantly related with the presence of carotid atherosclerosis were age, male sex, and systolic blood pressure. Interestingly, 592 (25.1%) individuals were reclassified to a higher risk due to the presence of carotid atherosclerosis.

Conclusions

There was a clear dissociation between cardiovascular risk scoring and the presence of atherosclerosis, because 1 of 4 study participants at low-to-intermediate cardiovascular risk had carotid atherosclerosis.

Resumen

Introducción y objetivos

Detectar la ateromatosis carotídea puede ser útil para mejorar la identificación de individuos susceptibles de padecer eventos cardiovasculares. Por ello, el objetivo de este estudio es cuantificar a los sujetos con riesgo cardiovascular bajo–intermedio según las fórmulas basadas en factores de riesgo tradicionales que presentan ateromatosis carotídea y, por lo tanto, tienen un riesgo alto de eventos cardiovasculares.

Métodos

Se trata de un estudio transversal y observacional llevado a cabo por la Fundación Española del Corazón, en un programa de cribado poblacional. De los 3.778 voluntarios, se identificó y estudió a los que presentaban riesgo bajo-intermedio (n = 2.354). Se aplicaron los procedimientos estándar de examen físico y análisis de sangre. Se examinaron mediante ecografía las arterias carótidas común, bulbo e interna de ambos lados, para identificar la presencia de placa y se midió el grosor íntima-media en la carótida común. Se calculó el riesgo cardiovascular según la fórmula SCORE. Se realizó análisis estadístico bivariable y multivariable de los datos obtenidos.

Resultados

La media de edad de los participantes era 58,9 ± 15 años y el 43,8% eran varones. El 23,7% presentaba hipertensión y el 20,5%, hipercolesterolemia. La media de riesgo según la fórmula SCORE fue 1,47 ± 1,4. Tanto el grosor íntima-media como la prevalencia de placa carotídea aumentaron progresiva y significativamente (p > 0,005) en paralelo con las décadas de la vida. Las variables significativamente relacionadas con la presencia de placa carotídea fueron edad, sexo masculino y presión arterial sistólica. Hay que destacar que se reclasificó a 592 (25,1%) sujetos a riesgo más elevado debido a la presencia de placa carotídea.

Conclusiones

Existe una clara disociación entre la estratificación del riesgo cardiovascular mediante los factores de riesgo tradicionales y la presencia de placa ateromatosa, ya que 1/4 sujetos con riesgo cardiovascular bajo-intermedio presentaba ateromatosis carotídea.

Section snippets

INTRODUCTION

Primary prevention of cardiovascular diseases (CVD) is based on the identification of high-risk individuals. However, the traditional cardiovascular risk factor approach is not efficient and not adequately inclusive. Interestingly, just 1 out of 4 young participants with coronary heart disease met the National Cholesterol Education Program criteria for treatment with statins, leading researchers to conclude that the risk factor approach underappreciates risk, especially in young people.1

Design and Procedures

This is a cross-sectional, observational study performed in 7 cities in Spain (Alicante, Ourense, Barcelona, Madrid, Valladolid, Zaragoza, and Sevilla) during a 1-year information campaign run by the Spanish Heart Foundation and both the Spanish and European Societies of Cardiology. The study was organized similarly in each city during a whole weekend (Saturday and Sunday). A specific place (consisting of several large tents) was established in a centric or highly crowded place and

General Characteristics and Atherosclerosis Assessment

We screened 3778 individuals during the study, excluding 938 because of diagnoses of type 2 diabetes mellitus, previous coronary heart disease or stroke, or a SCORE cardiovascular risk value >5%. Of the remaining pool (2840) of participants, 2354 individuals had the full examination. General characteristics of the population included in the study, by decades of life, are listed in Table 1.

Mean age was 58.9 (15) years and 43.8% were males. The distribution between males/females was not

DISCUSSION

CVD are the leading cause of death in industrialized countries and many of them are atherosclerosis-related events. The aim of the current study was to quantify the burden of atherosclerosis (measured by c-IMT and the presence of carotid plaques) noninvasively in a group of apparently healthy individuals with low-to-intermediate cardiovascular risk according to SCORE. The main result is that 25.1% of individuals have carotid plaques. We have to highlight that these participants were not

CONCLUSIONS

As CVD remain the number one killer in the developed world, additional efforts to better define preclinical disease need to be developed and adopted. Carotid ultrasound assessment of preclinical atherosclerosis is valued for the assessment of atherosclerosis and in predicting CVD, and according to our data 25.1% of apparently healthy participants at low-to-intermediate cardiovascular risk according to SCORE presented with carotid plaques. These results are encouraging. Now it may be time to

CONFLICTS OF INTEREST

None declared.

Acknowledgements

We are especially thankful to UDETMA components for their involvement in the current research project. GE Healthcare Spain was actively involved in the logistics and in providing the ultrasound portable devices (Sonia Mora, Mario Lois and Juan Antonio Beceiro). We also thank the Spanish Society of Cardiology and the Spanish Heart Foundation for the organization of the screening program.

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