Non-invasive subclinical arterial disease assessment improved accuracy for CV risk stratificacion

Several risk stratification charts are used in clinical practice to assess absolute risk for coronary heart disease (CHD) and to identify patients (pts) for aggressive medical therapies in primary prevention. On the other hand, subclinical atherosclerosis (SA) detection in peripheral arteries, as a measurement of atherosclerosis burden, can be used to predict coronary events. The aim of this study was to assess and compare SA prevalence in dislipidemic pts considered at low risk of future events by different risk charts. Noninvasive measurements of SA were performed using high resolution carotid and femoral ultrasonography, in 151 dislipidemic pts, mean age: 53±12 (20-82) yrs, males: 45%, BMI: 26±3 kg/m2, hypertensive: 42%, current smokers: 17%, diabetics: 3%, and family history of dyslipidemia: 56%. SA was defined as intima-media thickness (IMT) ≥0.8 mm and/or the presence of atherosclerotic plaques. Short-term office-based absolute CHD risk (<10 yrs) was estimated as determined for Framingham scoring, through three risk charts: Adult Treatment Panel III (ATP III), American Heart Association/American College of Cardiology (AHA/ACC), and II Task Force of the Joint European and other Societies on Coronary Prevention (II ESCP). Low-risk state was defined as a 10-year absolute risk for developing CHD of <10%. Pts were categorized by the three charts, low-risk group was identified for each chart. Prevalence of SA was compared among each estimated low-risk group. Continous variables were described by average ± SD and compared through Student's t-test. Non continous variables were described by percentages and compared by chi square test. All tests were two-sided at .05 level of significance. No significant differences were observed neither in SA prevalence among the estimated low-risk groups, nor after correction for gender, age and hypertension. SA presence was detected in almost two thirds of dislipidemic and low-risk groups of pts. Non-invasive subclinical arterial disease assessment may improve accuracy of risk stratification for pts found to be at low risk by office-based assessment. It should allow early appropriate interventions for CHD prevention. (See Table)