Effects of an Office-Based Carotid Ultrasound Screening Intervention

Abstract

Background Carotid ultrasound screening (CUS) has been recommended for cardiovascular disease (CVD) risk prediction; however, its effectiveness in clinical practice is unknown. The purpose of this study was to prospectively determine the effects of office-based CUS on physician decision-making and patient health-related behaviors (HRBs). Methods Physicians from 5 non-academic, community practices recruited patients ≥40 years old with ≥1 CVD risk factor. Abnormal carotid ultrasound screening (AbnlCUS) was defined as carotid intima-media thickness >75th percentile or carotid plaque presence. Subjects completed questionnaires before and immediately after CUS, then 30 days later to determine self-reported behavioral changes. Odds ratios (OR) for changes in physician management and patient HRBs were determined from multivariate hierarchical logistic regression models. Results There were 355 subjects (mean [standard deviation] 53.6 [7.9] years old, 2.3 [0.9] risk factors, 58% women); 266 (74.9%) had AbnlCUS. Presence of AbnlCUS altered physicians’ prescription of aspirin (p<0.001) and cholesterol medications (p<0.001). Immediately after CUS, subjects reported increased ability to change HRBs (p=0.002), regardless of their test results. Subjects with AbnlCUS reported increased CVD risk perception (OR 4.14, p<0.001), intentions to exercise (OR 2.28, p=0.008), make dietary changes (OR 2.95, p<0.001), and quit smoking (OR 4.98, p=0.022). After 30 days, 34% increased exercise frequency and 37% reported weight loss; but these changes were not predicted by the CUS results. AbnlCUS modestly predicted reduced dietary sodium (OR 1.45, p=0.002) and increased fiber (OR 1.55, p=0.022) intake. Conclusions Finding abnormal results on CUS had major effects on physician but not patient behaviors.

The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation

“…In practice, high cIMT values and/or presence of plaque are considered as target organ damage and call for aggressive risk factor modification. Though there are no studies to support such practices, carotid ultrasound scanning for detection of increased cIMT or carotid plaque may lead to increased prescription of aspirin and statins by physicians [41] and intensified goal setting for LDL-cholesterol levels [42]. However, conflicting results have been reported regarding the impact of carotid ultrasound scanning on patient motivation [41,43].…”

Carotid ultrasonography in the assessment of cardiovascular risk

“…In addition, some studies suggest that carotid evaluation does not seem to motivate patients to follow a healthy lifestyle or to improve treatment adherence [70,71]. Nevertheless CIMT and/or carotid plaque detection in subjects at low or intermediate risk can…”

The Role of Carotid Ultrasound for Cardiovascular Risk Stratification beyond Traditional Risk Factors

“…When abnormal results are found on carotid ultrasound screening, physicians are more likely to prescribe aspirin and lipid-lowering medication 36. However, recent meta-analyses suggested that aspirin may not offer benefits for primary prevention of cardiovascular disease when considering the increase in bleeding risk 37,38.…”