Effect of carotid atherosclerosis screening on risk stratification during primary cardiovascular disease prevention

Bard, Robert L.; Kalsi, Henna; Rubenfire, Melvyn; Wakefield, Thomas W.; Fex, Beverly A.; Rajagopalan, Sanjay; Brook, Robert D.

doi:10.1016/j.amjcard.2003.12.056

Cited by 54 publications

(17 citation statements)

References 8 publications

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“…Although not all patients with underlying atherosclerotic plaque experience clinical cardiovascular events, the degree of subclinical atherosclerosis is positively associated with a higher risk of future cardiovascular events [27][28][29][30][31] . In order to prevent morbidity and mortality from cardiovascular disease, there is great interest in identifying asymptomatic patients at high risk who may be candidates for more intensive, evidence-based medical interventions 27,28) .…”

Section: Resultsmentioning

confidence: 99%

Impact of the Serum Uric Acid Level on Subclinical Atherosclerosis in Middle-aged and Elderly Chinese

Chen

Sun

et al. 2015

JAT

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Aim:The carotid intima-media thickness (CIMT) is now validated as a sensitive marker of atherosclerosis and is directly associated with an increased risk of cardiovascular disease. Considering that the independent association between the serum uric acid level and CIMT remains controversial due to the complex interrelationship with other known cardiovascular risk factors, further studies are needed. The aim of the present study is to explore the association between the serum uric acid level and CIMT in a general Chinese population and determine whether the association differs according to varied metabolic status. Methods: The present study was cross-sectional in design. A total of 10,281 community-based participants 40 years of age or older from Shanghai, China were included in the current analysis. All participants underwent a detailed questionnaire interview, anthropometric measurements and ultrasonography to assess the CIMT. Blood and urine samples were collected for the biochemical measurements. Results: The serum uric acid levels were positively associated with obesity-and diabetes-related parameters and the CIMT. In a logistic regression model controlling for potential confounders, compared with the participants in the first quartile of the uric acid level, those in the fourth quartile had a higher odds of an elevated CIMT in both men (odds ratio [OR] 1.37; 95% confidence interval [CI] 1.07-1.75) and women (OR 1.48; 95% CI 1.12-1.94). The subgroup analyses revealed that an association between an elevated CIMT and the serum uric acid level persisted regardless of diuretic use and the hypertension, diabetes mellitus and chronic kidney disease status. However, the association disappeared in the patients who consumed alcohol and in premenopausal women. Conclusions: The serum uric acid level is positively associated with an elevated CIMT in middleaged and elderly Chinese subjects, independent of known risk determinants of cardiovascular disease. J Atheroscler Thromb, 2015; 22: 823-832.

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Section: Resultsmentioning

confidence: 99%

Impact of the Serum Uric Acid Level on Subclinical Atherosclerosis in Middle-aged and Elderly Chinese

Chen

Sun

et al. 2015

JAT

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“…25 Perhaps the basis for defining an abnormal intima-media thickness need to be more effective: 21 some studies have suggested that patients with values > 1.0 mm should be treated more aggressively, 21 even including use of lipid-lowering therapies. All statins have demonstrated regression in carotid intima-media thickness.…”

Section: Discussionmentioning

confidence: 99%

“…21,22 Intimamedia thickness is widely used as a marker for early carotid atherosclerosis. 4,23 Knowing the intima-media thickness is considered to improve cardiovascular risk assessments particularly among patients with intermediate Framingham scores.…”

Section: Discussionmentioning

confidence: 99%

Relationship between cardiovascular risk factors and the echogenicity and pattern of the carotid intima-media complex in men

et al. 2014

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Relationship between cardiovascular risk factors and the echogenicity and pattern of the carotid intima-media complex in menRelação entre os fatores de risco cardiovascular e a ecogenicidade e o padrão do complexo íntima-média carotídeo em homens ABSTRACTCONTEXT AND OBJECTIVE: The thickness of the carotid intima-media complex (C-IMC) is considered to be a marker of early atherosclerosis, but visual and echogenic changes to the C-IMC can also be noted. The objective here was to evaluate the relationship between cardiovascular risk factors and the echogenicity of the C-IMC and identify those most associated with an "abnormal" C-IMC. DESIGN AND SETTING: Cross-sectional study in the ultrasound sector of the Department of Diagnostic Imaging, Universidade Federal de São Paulo. METHODS: Eighty men were evaluated. Measurements of arterial blood pressure, waist circumference (WC), lipid profile, fasting glucose, uric acid and high-sensitivity C-reactive protein were obtained. The thickness of the C-IMC was measured by means of B-mode ultrasound, and the intima-media grayscale mean (IM-GSM) and standard deviation (IM-SD) were calculated. RESULTS: The following were discriminating variables: fasting glucose (r 2 = 0.036; P = 0.013), uric acid (r 2 = 0.08; P = 0.03), IM-SD (r 2 = 0.43; P < 0.001), IM-GSM (r 2 = 0.35; P < 0.001) and thickness of the C-IMC (r 2 = 0.29; P < 0.001). IM-GSM showed significant correlations with WC (r = -0.22; P = 0.005), fasting glucose (r = -0.24; P = 0.002) and high-density lipoprotein cholesterol (HDL-C) (r = 0.27; P = 0.0007). CONCLUSION: IM-GSM showed correlations with WC, fasting glucose and HDL-C. However, uric acid and IM-SD presented the greatest discriminating impact. These results suggest that visual changes in C-IMC may help identify patients with potential cardiovascular risk, independently of the thickness of the C-IMC. RESUMOCONTEXTO E OBJETIVO: A espessura do complexo íntima-média carotídeo (CIM-C) é considerada um marcador da aterosclerose precoce, mas alterações visuais e da ecogenicidade do CIM-C também podem ser observadas. O objetivo foi avaliar a relação entre os fatores de risco cardiovascular e a ecogenicidade do CIM-C e identificar aqueles mais relacionados com o CIM-C "alterado". TIPO DE ESTUDO E LOCAL: Estudo transversal no setor de ultrassonografia do Departamento de Diagnóstico por Imagem, Universidade Federal de São Paulo. MÉTODOS: Oitenta homens foram avaliados. Aferição da pressão arterial, medida da circunferência abdominal (CA), perfil lipídico, glicemia de jejum (GLI), ácido úrico (AU) e proteína C-reativa de alta sensibilidade foram obtidos. A espessura do CIM-C foi medida por ultrassom modo B e a média da escala de cinza (GSM) e do desvio padrão do CIM (DPIM) foram calculados. RESULTADOS: As variáveis discriminantes foram GLI (r 2 = 0,036; P = 0,013), AU (r 2 = 0,08; P = 0,03), DPIM (r 2 = 0,43; P < 0,001), GSM (r 2 = 0,35; P < 0,001) e espessura do CIM-C (r 2 = 0.29; P < 0,001). Houve correlação significativa entre GSM e CA (r = -0,22; P = 0,005), GLI (r = -...

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“…In a small cohort of patients who had intermediate Framingham CV risk scores, 55% had carotid plaque. 47 Of those without plaque, 88% had CIMT Ͻ1.0 mm, indicating the absence of high CV risk. 47 Data from the BRHS demonstrated that this type of screening tool may be more powerful in women, since only one of 16 women with carotid plaque had a CIMT Ͼ1.0 mm, in contrast with one in four men.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-detected carotid plaque as a predictor of cardiovascular events

et al. 2006

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IntroductionMore than half of men and women who die suddenly of cardiovascular (CV) disease have no previous symptoms. 1 A simple, non-invasive, reliable, and inexpensive tool to screen individuals for CV disease prior to the development of symptoms would be very useful for primary care and specialty physicians, to help target treatment strategies towards individuals at the highest risk. Although multiple risk factor CV risk prediction models are used widely, their estimates are heavily dependent on age, do not account for changes in a patient's health status over time, and are focused on short-term (10-year) risk. 2 Use of the Framingham CV risk model is recommended by current guidelines; however, it does not incorporate family history of CV disease-a matter of great consequence to patients-into its estimates. Also, it is hard to reconcile the modest number of patients who are at increased 10-year risk by the Framingham CV risk model with the observation that the lifetime risk of coronary artery disease (CAD) starting at age 40 years is 49% for men and 32% for women. 3,4 To improve CV risk prediction, some have advocated the use of imaging to determine the ankle-brachial pressure index, extent of coronary artery calcification, or carotid intima-media thickness (CIMT). 5 Although these tests may be useful in selected patients, in many instances they are either insensitive, non-specific, impractical, or too expensive to perform routinely. 6,7 Ultrasound detection of carotid plaque is as safe as measuring CIMT, but is less timeconsuming. It can be performed with ultrasound equipment available in many clinical environments and may identify patients at increased risk of CV disease. We reviewed the literature to determine the CV risk factors associated with the presence of carotid plaque and whether its presence is associated with the presence and extent of CAD. A MEDLINE search subsequently was performed to determine whether carotid plaque predicts future CV events. Carotid plaque is associated with traditional and non-traditional CV risk factorsSeveral studies have demonstrated strong associations between the presence or extent of carotid plaque and traditional CV risk factors. [8][9][10][11][12][13][14][15][16] Age most commonly is associated with carotid plaque. [8][9][10][11][12][13] In one study, this Abstract: Ultrasound detection of carotid plaque can be performed with equipment that is available in many clinical settings and can identify patients at increased risk of cardiovascular (CV) disease. We reviewed the literature to determine the CV risk factors associated with the presence of carotid plaque and whether its presence is associated with the presence and extent of coronary artery disease. A MEDLINE search subsequently was performed to determine whether carotid plaque burden predicts future CV events. Studies that had more than 300 subjects and reported hazard ratios or relative risk estimates for CV events, or data from which these values could be calculated, were included. References from identified ...

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Effect of carotid atherosclerosis screening on risk stratification during primary cardiovascular disease prevention

Cited by 54 publications

References 8 publications

Impact of the Serum Uric Acid Level on Subclinical Atherosclerosis in Middle-aged and Elderly Chinese

Impact of the Serum Uric Acid Level on Subclinical Atherosclerosis in Middle-aged and Elderly Chinese

Relationship between cardiovascular risk factors and the echogenicity and pattern of the carotid intima-media complex in men

Ultrasound-detected carotid plaque as a predictor of cardiovascular events

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