Early Diagnosis and Treatment of Coronary Heart Disease in Asymptomatic Subjects With Advanced Vascular Atherosclerosis of the Carotid Artery (Type III and IV b Findings Using Ultrasound) and Risk Factors

Abstract

BackgroundA study was conducted as to whether the early diagnosis of coronary heart disease in asymptomatic subjects with advanced atherosclerosis of the carotid artery which additionally shows at least one risk factor is successful using ultrasound technology.MethodsWithin the scope of an occupational screening program using subjects from diverse employment sectors, people were given the opportunity to determine their risk of heart attack. During the study the total plaque area (TPA), the maximum plaque thickness in the carotid artery and the PROCAM-Scores of 3,748 healthy men and 2,260 healthy women between the ages of 20 and 64 years were determined. During the subsequent follow-up study 94 subjects sickened. An ultrasound examination of the carotid artery of 79 patients revealed a type III or IV b finding. In a pilot study 33 asymptomatic subjects with a type III or IV b finding in the ultrasound examination were assessed using a computed tomography (CT) coronary angiogram. Additional 10 asymptomatic subjects were examined independently to undergo further cardiac examinations.ResultsIn the final analysis only five patients had entirely smooth coronary arteries, six had coronary sclerosis, eight had a 30% stenosis, one had a 30-50% stenosis and 23 patients had a stenosis ≥ 50%; and in extreme case, a left main coronary artery stenosis with three-vessel disease.ConclusionsAsymptomatic subjects with advanced atherosclerosis of the carotid artery (type III and type IV b findings) had a high risk for coronary heart disease (CHD). Early treatment of the disease improves the patient's prognosis. A screening consisting in the combination of TPA measurement and determining the maximum plaque thickness is recommended.

MicroRNA-140-5p aggravates hypertension and oxidative stress of atherosclerosis via targeting Nrf2 and Sirt2

“…AS is considered the pathological basis for the occurrence and progression of coronary heart disease (16). miRNAs are a group of endogenous conserved non-coding small-molecule single-stranded RNAs that are widely distributed in eukaryotes and are involved in the regulation of gene expression at the post-transcription level (16). Previous studies have identified that the expression of miRNA is associated with the formation of atherosclerotic plaques (11,17).…”

Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography

“…33 Similarly, asymptomatic subjects with advanced atherosclerosis of the carotid artery (carotid plaques with a CIMT $ 3.5 mm and flat carotid plaques with a CIMT > 2 mm) have been shown to have a high risk of coronary heart disease. 34 In the High Risk Plaque (HRP) Bioimage study, hazard ratios for major adverse cardiovascular events (MACE) for the maximum carotid plaque thickness were 1.96 (95% CI 0.91-4.25, p = 0.015) for primary MACE [cardiovascular death, myocardial infarction, or stroke] and 3.13 (95% CI 1.80-5.51, p < 0.001) for secondary MACE (all-cause death, MI, ischemic stroke, unstable angina, or coronary revascularization). 35 Advantages.…”

Monocyte/lymphocyte ratio is associated with carotid stenosis in ischemic stroke: A retrospective analysis

“…Therefore, an early detection of ischemic stroke and its prevention have important practical significance, which may ultimately lead to better health outcomes and reduce the financial burden inherent to diseases associated with a long-term disability. Carotid artery stenosis is closely related to ischemic stroke (Eckstein et al, 2013;Gupta et al, 2012;Lu & Wang, 2016) and is mainly caused by carotid atherosclerosis (Adams, Bojara, & Schunk, 2018;Liu et al, 2017) because of embolic sequelae as a consequence of underlying atherosclerosis which can incur/ cause secondary hemodynamic disturbances. The role of inflammation in the pathogenesis of carotid atherosclerosis has been well established (Borne et al, 2017;Casiglia & Tikhonoff, 2007), and the role of various inflammatory cells and mediators involved in carotid disease and stroke should be well investigated in order to better predict/ identify at-risk patients (Ammirati, Moroni, Norata, Magnoni, & Camici, 2015;Casiglia & Tikhonoff, 2007;Horne et al, 2005;Woollard & Geissmann, 2010).…”

“…Carotid artery stenosis is closely related to ischemic stroke (Eckstein et al, 2013;Gupta et al, 2012;Lu & Wang, 2016) and is mainly caused by carotid atherosclerosis (Adams, Bojara, & Schunk, 2018;Liu et al, 2017) because of embolic sequelae as a consequence of underlying atherosclerosis which can incur/ cause secondary hemodynamic disturbances. Carotid artery stenosis is closely related to ischemic stroke (Eckstein et al, 2013;Gupta et al, 2012;Lu & Wang, 2016) and is mainly caused by carotid atherosclerosis (Adams, Bojara, & Schunk, 2018;Liu et al, 2017) because of embolic sequelae as a consequence of underlying atherosclerosis which can incur/ cause secondary hemodynamic disturbances.…”