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

Abstract

Primary prevention and early detection of cardiovascular disease is important, as it is the leading cause of death throughout world. Risk stratification algorithms, such as Framingham Risk Score and European Systematic Coronary Risk Evaluation, that utilize a combination of various traditional risk factors have been developed to improve primary prevention. However, the accuracy of these algorithms for screening high risk patients is moderate at best. Accordingly, the use of biomarkers or imaging studies may improve risk stratification. Carotid ultrasound, which measures both carotid intima-media thichkness (cIMT) and carotid plaque, is useful in detecting the degree of subclinical carotid atherosclerosis, and has the advantage of being noninvasive and safe. Several large epidemiologic studies have indicated that cIMT and carotid plaque are closely related with other cardiovascular risk factors and may be useful for risk reclassification in subjects deemed to be at intermediate risk by traditional risk scores. Moreover, recent clinical guidelines for management of hypertension or dyslipidemia highlight the usefulness of cIMT in high risk patients. In this article, we review evidence for the usefulness of measurement of cIMT and carotid plaque for cardiovascular risk stratification.

Risk factors of carotid plaque and carotid common artery intima‐media thickening in a high‐stroke‐risk population

“…Therefore, primary prevention and detection of atherosclerosis as well as modifications of the risk factors are quite important. Carotid ultrasound can detect the degree of carotid atherosclerosis by measuring CIMT and CP (Lee & Park, 2014). …”

Immune Activation, Immunosenescence, and Osteoprotegerin as Markers of Endothelial Dysfunction in Subclinical HIV-Associated Atherosclerosis

“…Several studies showed that the measurement of c-IMT has been correlated with the extent of coronary atherosclerosis and that the increase of c-IMT is predictive of future CVD events. c-IMT is strongly associated with the traditional risk factors such as male sex, ageing, overweight, high blood cholesterol, diabetes and insulin resistance, smoking, and, in particular, elevated blood pressure, probably due to media hypertrophy [ 16 ]. New or emerging risk factors such as various lipoproteins, psychosocial status, plasma viscosity, and hyperhomocysteinemia have also been associated with c-IMT values.…”

“…Given the morbidity and the mortality associated with overt CVD, early identification and management of subclinical disease are desirable before complications of overt CVD develop [ 15 ]. Measurement of carotid intima-media thickness (c-IMT) has previously been correlated with the extent of coronary atherosclerosis and increases in c-IMT are predictive of future CVD events [ 16 ]. The aim of our study was to investigate the relationship of lymphocytes T-cell phenotype, IL-6, and OPG plasma levels with atherosclerosis evaluated by c-IMT in HIV-positive patients on suppressive ART.…”

Is carotid sonography a useful tool for predicting functional capabilities in ischemic stroke patients following carotid artery stenting?

“…Extracranial carotid ultrasound [5] is noninvasive and mobile, and requires no contrast medium, making it a useful assessment tool in carotid stenosis stroke patients. [6] However, the role of carotid ultrasound in evaluating the blood flow between the prestenting and poststenting phases has, to the best of our knowledge, not been reported or validated in stroke patients with carotid stenosis.…”