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Health See other Health Articles Title: 3D Carotid Ultrasound May Reveal Hidden Atherosclerosis Reuters Health Information NEW YORK (Reuters Health) - 3D carotid ultrasound, with or without CT scans for coronary artery calcium, can identify subclinical atherosclerosis in people with no clinical manifestations, a new paper reports. If these results are confirmed by additional research, the findings would have broad implications because ultrasound is readily available, portable, without risk, readily repeatable, and doesn't expose patients to radiation, according to an editorial published with the results. Led by Dr. Valentin Fuster, director of Mount Sinai Heart and physician-in-chief of Mount Sinai Hospital in New York, the researchers first used coronary artery calcium (CAC) CT scans and 3D carotid ultrasound to evaluate the prevalence of subclinical atherosclerosis; then they assessed the impact of each technique on improving risk prediction and reclassification compared with traditional risk factors. In particular, they focused on near-term risk (i.e., within three years). As reported online March 24 in the Journal of the American College of Cardiology, the 5,808 asymptomatic adults in their study had an average age of 69. Slightly more than half (56.5%) were female and 74% were white. At baseline, 857 (14.8%) had diabetes, 496 (8.5%) smoked, and 3,614 (62.2%) had hypertension. The average body mass index (BMI) was 29. Subclinical atherosclerosis was highly prevalent, detectable in both vascular territories in close to 60% of participants, the researchers found. Over a median follow-up of 2.7 years, there were 216 first major adverse cardiovascular events (MACE), including 108 deaths (27 cardiovascular deaths), 34 spontaneous myocardial infarctions (MI), 30 ischemic strokes, 18 hospitalizations for unstable angina, and 79 coronary revascularization procedures. At three years, there had been 82 primary MACE events, with a cumulative incidence of 1.5%. Marked trends of higher risk were observed with increasing CAC and total carotid plaque burden (cPB) (log rank p<0.001 for all). Not surprisingly, at lowest risk were those without any measurable CAC or cPB. Risk was highest among those in the third tertile for both techniques. Significant trends for increasing risk associated with either CAC or cPB persisted even after adjusting for all risk factors for both endpoints. Formal interaction tests between CAC, cPB, and baseline use of lipid-lowering therapy were nonsignificant for both MACE endpoints. Quantifying atherosclerosis with either CAC or 3D ultrasound yielded comparable gains over classical risk factors in CVD risk prediction, the authors say, adding that studies of cost effectiveness are needed now "to define the optimal roles of these complementary techniques." Limitations of the study include the reliance on health insurance claims to identify adverse events, which may have resulted in lower than expected rates. Study participants were also older than typical primary prevention cohorts. In a phone interview, Dr. Fuster told Reuters Health, "Using imaging tests to detect disease in carotid or coronary arteries before it causes symptoms can better identify healthy individuals at increased risk than our current, traditional risk assessment methods." In an editorial, Dr. Tasneem Naqvi of the Mayo Clinic in Scottsdale, Arizona, agrees. Imaging-based assessment of atherosclerosis to predict CVD instead of a risk factor-based approach might help implement preventive intervention and thwart the increasing CVD toll, Dr. Naqvi writes. Dr. Naqvi notes, however, that the primary endpoint occurred in only 1.5% of the study cohort and the secondary endpoint in 4.2%, which she links to the short mean follow-up period and probable risk modification as a result of statin use during enrollment, which was not detailed in the study. She also points out that the plaque assessment was not real-time 3D using a 3D transducer, but a combination of 2D images obtained from a 2D transducer, because true 3D methods were not fully developed at the start of the study. In addition, the plaque was only assessed in the short-axis views, which may miss or poorly quantify plaque in tortuous or deep vessels, and may not delineate medial and lateral wall plaques because of the poor lateral resolution of ultrasound. To be sure, standard screening methods need improvement, Dr. Naqvi told Reuters Health in an email. "The current method of screening for future cardiovascular disease relies on known risk factors such as age, male gender, history of high blood pressure, diabetes, smoking and cholesterol and blood pressure values," Dr. Naqvi said. "This method is heavily biased for age and gender and thus identifies younger individuals and women as low risk." The screening options explored in the study, however, examine the vessels before CVD manifests itself and "identifies the atherosclerotic disease irrespective of someone known or unknown to have risk factors," Dr. Naqvi added. "Those who are found to have disease inside their arteries already have disease and hence they should be treated aggressively irrespective of what the clinical risk score comes out as." SOURCE: bit.ly/1C9mM7Q J Am Coll Cardiol 2015. Editors' Recommendations The Key Features of Percutaneous Coronary Intervention With Chronic Total Obstruction Lesion of Right Coronary Artery Cross-sectional Study: CagA–positive Helicobacter pylori Infection, Acute Coronary Artery Disease and Systemic Levels of B-type Natriuretic Peptide Screen or Not to Screen for Peripheral Arterial Disease: Guidance From a Decision Model Post Comment Private Reply Ignore Thread
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