Clinical ResearchEarly Atherosclerosis Detection in Asymptomatic Patients: A Comparison of Carotid Ultrasound, Coronary Artery Calcium Score, and Coronary Computed Tomography Angiography
Section snippets
Patient enrollment
From July 2010 to August 2011, asymptomatic patients seen at a cardiovascular risk reduction clinic in a quaternary referral centre (the Healthy Heart Program Prevention Clinic, St Paul's Hospital, Vancouver, British Columbia, Canada) who were scheduled to undergo a carotid US for clinical risk stratification were invited to undergo CCTA/CAC. Only patients aged 20 years or older who provided permission to be contacted for participation in research studies were offered participation. Patients
Results
A total of 50 subjects were included in the study. Subject recruitment is summarized in Figure 1. Baseline demographic characteristics of participants are shown in Table 1. Using carotid US, the percentage of individuals with measures of early atherosclerosis varied from 28% to 90% depending on the measure used (Table 2). Only 10% of individuals had a normal carotid US (IMT < 75th percentile with no plaque present).
On CCTA, 78% of individuals were found to have atherosclerosis, defined by the
Discussion
Subclinical atherosclerosis by any definition examined in this study was widely prevalent in this referral population when detailed analysis of 2 vascular beds was performed. The correlation of atherosclerosis detection using carotid US and CCTA was only moderate at best, and a significant proportion of individuals would not have been identified if only 1 modality for atherosclerosis detection was used. A CAC score of 0 was misleading in this young population (mean age, 53 years) with high
Conclusions
Despite these limitations, the potential effect of imaging for the purpose of risk stratification and initiation of intensive treatment is demonstrated strikingly and provides provocative and clinically important insights. Concordance between the modalities was highly variable, and dependent on the specific definition used. Carotid US and CCTA detection of plaque were more sensitive than CAC > 0. Considering the strong evidence for low cardiovascular risk in patients with CAC = 0, the threshold
Funding Sources
Dr C. Taylor received funding from the Providence Health Care Boehringer Ingelheim Heart Centre Physician Scholar Award which helped to support this work.
Disclosures
Dr J. Leipsic has worked on medical advisory boards and is on the speakers bureau for GE Healthcare. All other authors have no conflicts of interest to disclose.
References (26)
- et al.
2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult
Can J Cardiol
(2013) - et al.
ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation clinical expert consensus task force (ACCF/AHA writing committee to update the 2000 expert consensus document on electron beam computed tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography
J Am Coll Cardiol
(2007) Screening asymptomatic subjects for sublinical atherosclerosis can we, does it matter, and should we?
J Am Coll Cardiol
(2010)- et al.
SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography
J Cardiovasc Comput Tomogr
(2009) - et al.
A method for coronary artery calcium scoring using contrast-enhanced computed tomography
J Cardiovasc Comput Tomogr
(2012) - et al.
Quantification of coronary artery calcium using ultrafast computed tomography
J Am Coll Cardiology
(1990) - et al.
Carotid intima-media thickness and coronary artery calcium score as indicators of subclinical atherosclerosis
Mayo Clin Proc
(2009) - et al.
Carotid plaque burden as a measure of subclinical atherosclerosis: comparison with other tests for subclinical arterial disease in the High Risk Plaque BioImage study
JACC Cardiovasc Imaging
(2012) - et al.
Risk stratification for the detection of preclinical coronary artery disease
Circulation
(1999) - et al.
Identifying adults at increased risk of coronary disease
JAMA
(1995)
The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels
N Engl J Med
Centers for Disease Control and Prevention (CDC). Coronary heart disease and stroke deaths - United States, 2006
MMWR Surveill Summ
General cardiovascular risk profile for use in primary care: the Framingham Heart Study
Circulation
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2019, Clinica Chimica ActaCitation Excerpt :However, a significant portion of the arterial wall can be involved with an atherosclerotic plague before the lumen is compromised [23]. Further, techniques such as carotid ultrasound and CT scan are only moderate at best for detection of subclinical atherosclerosis [24]. Therefore, it is necessary to find an appropriate biomarker that will allow the diagnosis of atherosclerosis at the earliest possible stage.
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