Clinical InvestigationCardiovascular Risk Assessment by Cardiovascular UltrasoundCarotid Ultrasound Identifies High Risk Subclinical Atherosclerosis in Adults with Low Framingham Risk Scores
Section snippets
Patient Selection
Upon obtaining approval from the Mayo Clinic Institutional Review Board, the medical records of all 688 patients at our institution who underwent CIMT examinations between January 1, 2007, and December 31, 2008, were retrospectively reviewed. Clinical data were collected from the electronic medical records and an FRS was calculated for each subject. Subjects aged > 65 years, those with diabetes mellitus, those with histories of coronary artery disease, and those with incomplete clinical data
Results
Subjects (n = 441) had an average age of 49.7 ± 7.9 years, and there was a predominance of men (70%). The average FRS was 4.5 ± 4.2%. Of these subjects, 184 (42%; 95% CI, 37.3%-46.5%) had high-risk carotid ultrasound results; 90 (20%) had carotid plaque and 94 (21%) had CIMT ≥ 75th percentile for age-matched, gender-matched, and race-matched controls. The average body mass index was 27.5 ± 5.3 kg/m2, 59 subjects (13%) had family histories of premature coronary artery disease, 34 (8%) were
Discussion
Currently, traditional risk factors and the calculated FRS are the primary methods used to identify asymptomatic individuals with atherosclerosis who may benefit from more aggressive primary preventive therapy. Our principal finding is that 38% of asymptomatic young to middle-aged individuals with low FRS who are not on lipid-lowering medications have findings on carotid ultrasound examination that put them at higher risk for future adverse CV events. Our study was unique in that it included
Conclusions
Carotid ultrasound identifies a higher risk subgroup in a large percentage of asymptomatic young to middle-aged individuals with low FRS. Furthermore, pharmacologic therapy for CV prevention was recommended in the majority of these individuals. These findings, along with its lack of radiation exposure, relatively low cost, and ability to detect early-stage atherosclerosis, suggest that carotid ultrasound for CIMT and plaque detection should be further explored as a primary tool for CV risk
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