Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients

Abstract

Background The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established. Aims We aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratification in guidelines-defined high ASCVD risk patients. Methods We consecutively analysed high or very high ASCVD risk patients from a cardiovascular (CV) prevention registry (n = 751, derivation cohort) and from the Atherosclerosis Risk in Communities (ARIC) study (n = 2,897, validation cohort). Baseline ASCVD risk was defined using the 2021 European Society of Cardiology (ESC) guidelines (clinical ESCrisk). Intima-media thickness (IMT) excluding plaque, average maximal (avg.maxWT), maximal wall thickness (maxWT) and number of sites with carotid plaque were assessed. As primary endpoint of the study was defined the composite of cardiac death, acute myocardial infarction (MI) and revascularization after a median of 3.4 years in both cohorts and additionally for 16.7 years in the ARIC cohort. Results MaxWT > 2.00 mm and avg.maxWT > 1.39 mm provided incremental prognostic value, improved discrimination and correctly reclassified risk over the clinical ESCrisk both in the derivation and the validation cohort (p < 0.05 for NRI, IDI, and Delta Harrell’s C index). MaxWT < 0.9 mm predicted very low probability of cardiovascular events (negative predictive value = 97% and 92% in the derivation and validation cohort, respectively). These findings were additionally confirmed for very long-term events in the validation cohort. Conclusion Integration of carotid ultrasonography in guidelines-defined risk stratification may identify very high risk patients in need for further residual risk reduction or at very low probability for events.

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…55 Both high and low IMT improved risk prediction in an analysis of registry patients and ARIC study participants at high risk for CVD: Maximum wall thickness >2.0 mm improved net reclassification index, integrated discrimination index, and C index ( P <0.05); and maximum wall thickness <0.9 mm had a negative predictive value of 97% and 92% in the derivation and validation cohorts for CVD events. 56…”

Osteocalcin and Chinese visceral adiposity index are associated with the risk of ASCVD and arterial stiffness in patients with T2DM

“…Osteocalcin and CVAI may be potential biomarkers of cardiovascular risk and offer a fresh understanding of how to reduce residual cardiovascular risk [2]. Moreover, osteocalcin can be obtained directly from the blood [33,34], and CVAI is based on hematological indicators likely, as well as age, BMI, and WC. Considering that they are all able to objectively show changes in their levels at different stages of the disease, are universally available in all healthcare facilities (including primary healthcare facilities), and are inexpensive, osteocalcin and CVAI may be more favorable for improving ASCVD risk assessment in patients with T2DM [2].…”

Current Toolset in Predicting Acute Coronary Thrombotic Events: The “Vulnerable Plaque” in a “Vulnerable Patient” Concept

“…Contrary to invasive imaging technologies that focus on patients diagnosed with CAD, non-invasive strategies provide opportunities for identifying coronary atherosclerosis in asymptomatic people [ 134 ]. In asymptomatic individuals, the event rate is significantly lower, and, thus, regardless of whether future studies prove the prognostic importance of imaging, the cost-effectiveness of such methods must be analyzed before incorporating them in clinical practice [ 3 ].…”