High prevalence of ultrasound detected carotid atherosclerosis in subjects with low framingham risk score

Potential implications for screening for subclinical atherosclerosis

Tasneem Zehra Naqvi, Fernando Mendoza, Farhad Rafii, Heidi Gransar, Maria Guerra, Norman Lepor, Daniel S. Berman, Prediman K. Shah

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: The cardiovascular (CV) risk assigned by the Framingham risk score (FRS) misses many subjects destined for CV events. Coronary artery calcification (CAC) as measured by computed tomography and carotid intima-media thickness (CIMT) and plaque assessment using B-mode ultrasound can identify subclinical atherosclerosis. The comparative relation of CAC and CIMT and carotid plaque after integration into the FRS is not established. The aim of this study was to develop a CV screening approach incorporating FRS, CAC, and CIMT. Methods: The prevalence of subclinical atherosclerosis, defined as CAC score > 0, CIMT ≥ 75th percentile, or plaque ≥ 1.5 mm, was determined in the groups with low, intermediate, and high FRS among 136 asymptomatic subjects. The CIMT and CAC values were used to determine "vascular age" and "coronary calcium" age, respectively, with established nomograms. Results: In the 103 low-risk (FRS < 10%) subjects, 41%, 50%, 59%, and 66% had CAC scores > 0, CIMT ≥ 75th percentile, plaque ≥ 1.5 mm, and CIMT ≥ 75th percentile or plaque ≥ 1.5 mm, respectively. In the 33 subjects with intermediate (n = 14) or high (n = 19) FRS, 70%, 81%, 87%, and 87% had CAC scores > 0, CIMT ≥ 75th percentile, plaque ≥ 1.5 mm, and CIMT ≥ 75th percentile or plaque ≥ 1.5 mm, respectively. Fifty-two percent of subjects with coronary calcium scores of zero had carotid plaque. Adjusted for FRS, body mass index was an independent predictor of abnormal CIMT in the low-FRS group, but not of abnormal CAC. Mean vascular CIMT age was significantly higher than coronary calcium age (61.6 ± 11.4 vs 58.3 ± 11.1 years, P = .001), and both were significantly higher than chronologic age (56.9 ± 10.1 years) (P < .0001 and P < .04, respectively). CIMT upgraded or downgraded FRS by >5% in more cases than CAC (42% vs 17%). Conclusion: In asymptomatic patients without CV disease, CIMT and plaque assessment are more likely to revise FRS than CAC. Body mass index predicts increased CIMT in low-FRS subjects. These findings may have broad implications for screening in low-FRS subjects.

Original languageEnglish (US)
Pages (from-to)809-815
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume23
Issue number8
DOIs
StatePublished - 2010
Externally publishedYes

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Carotid Intima-Media Thickness
Carotid Artery Diseases
Atherosclerosis
Coronary Vessels
Calcium
Body Mass Index
Tunica Intima
Nomograms
Blood Vessels

Keywords

  • Atherosclerosis
  • Coronary calcium score
  • Imaging
  • Intima media thickness
  • Plaque

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

High prevalence of ultrasound detected carotid atherosclerosis in subjects with low framingham risk score : Potential implications for screening for subclinical atherosclerosis. / Naqvi, Tasneem Zehra; Mendoza, Fernando; Rafii, Farhad; Gransar, Heidi; Guerra, Maria; Lepor, Norman; Berman, Daniel S.; Shah, Prediman K.

In: Journal of the American Society of Echocardiography, Vol. 23, No. 8, 2010, p. 809-815.

Research output: Contribution to journalArticle

Naqvi, Tasneem Zehra ; Mendoza, Fernando ; Rafii, Farhad ; Gransar, Heidi ; Guerra, Maria ; Lepor, Norman ; Berman, Daniel S. ; Shah, Prediman K. / High prevalence of ultrasound detected carotid atherosclerosis in subjects with low framingham risk score : Potential implications for screening for subclinical atherosclerosis. In: Journal of the American Society of Echocardiography. 2010 ; Vol. 23, No. 8. pp. 809-815.
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T1 - High prevalence of ultrasound detected carotid atherosclerosis in subjects with low framingham risk score

T2 - Potential implications for screening for subclinical atherosclerosis

AU - Naqvi, Tasneem Zehra

AU - Mendoza, Fernando

AU - Rafii, Farhad

AU - Gransar, Heidi

AU - Guerra, Maria

AU - Lepor, Norman

AU - Berman, Daniel S.

AU - Shah, Prediman K.

PY - 2010

Y1 - 2010

N2 - Background: The cardiovascular (CV) risk assigned by the Framingham risk score (FRS) misses many subjects destined for CV events. Coronary artery calcification (CAC) as measured by computed tomography and carotid intima-media thickness (CIMT) and plaque assessment using B-mode ultrasound can identify subclinical atherosclerosis. The comparative relation of CAC and CIMT and carotid plaque after integration into the FRS is not established. The aim of this study was to develop a CV screening approach incorporating FRS, CAC, and CIMT. Methods: The prevalence of subclinical atherosclerosis, defined as CAC score > 0, CIMT ≥ 75th percentile, or plaque ≥ 1.5 mm, was determined in the groups with low, intermediate, and high FRS among 136 asymptomatic subjects. The CIMT and CAC values were used to determine "vascular age" and "coronary calcium" age, respectively, with established nomograms. Results: In the 103 low-risk (FRS < 10%) subjects, 41%, 50%, 59%, and 66% had CAC scores > 0, CIMT ≥ 75th percentile, plaque ≥ 1.5 mm, and CIMT ≥ 75th percentile or plaque ≥ 1.5 mm, respectively. In the 33 subjects with intermediate (n = 14) or high (n = 19) FRS, 70%, 81%, 87%, and 87% had CAC scores > 0, CIMT ≥ 75th percentile, plaque ≥ 1.5 mm, and CIMT ≥ 75th percentile or plaque ≥ 1.5 mm, respectively. Fifty-two percent of subjects with coronary calcium scores of zero had carotid plaque. Adjusted for FRS, body mass index was an independent predictor of abnormal CIMT in the low-FRS group, but not of abnormal CAC. Mean vascular CIMT age was significantly higher than coronary calcium age (61.6 ± 11.4 vs 58.3 ± 11.1 years, P = .001), and both were significantly higher than chronologic age (56.9 ± 10.1 years) (P < .0001 and P < .04, respectively). CIMT upgraded or downgraded FRS by >5% in more cases than CAC (42% vs 17%). Conclusion: In asymptomatic patients without CV disease, CIMT and plaque assessment are more likely to revise FRS than CAC. Body mass index predicts increased CIMT in low-FRS subjects. These findings may have broad implications for screening in low-FRS subjects.

AB - Background: The cardiovascular (CV) risk assigned by the Framingham risk score (FRS) misses many subjects destined for CV events. Coronary artery calcification (CAC) as measured by computed tomography and carotid intima-media thickness (CIMT) and plaque assessment using B-mode ultrasound can identify subclinical atherosclerosis. The comparative relation of CAC and CIMT and carotid plaque after integration into the FRS is not established. The aim of this study was to develop a CV screening approach incorporating FRS, CAC, and CIMT. Methods: The prevalence of subclinical atherosclerosis, defined as CAC score > 0, CIMT ≥ 75th percentile, or plaque ≥ 1.5 mm, was determined in the groups with low, intermediate, and high FRS among 136 asymptomatic subjects. The CIMT and CAC values were used to determine "vascular age" and "coronary calcium" age, respectively, with established nomograms. Results: In the 103 low-risk (FRS < 10%) subjects, 41%, 50%, 59%, and 66% had CAC scores > 0, CIMT ≥ 75th percentile, plaque ≥ 1.5 mm, and CIMT ≥ 75th percentile or plaque ≥ 1.5 mm, respectively. In the 33 subjects with intermediate (n = 14) or high (n = 19) FRS, 70%, 81%, 87%, and 87% had CAC scores > 0, CIMT ≥ 75th percentile, plaque ≥ 1.5 mm, and CIMT ≥ 75th percentile or plaque ≥ 1.5 mm, respectively. Fifty-two percent of subjects with coronary calcium scores of zero had carotid plaque. Adjusted for FRS, body mass index was an independent predictor of abnormal CIMT in the low-FRS group, but not of abnormal CAC. Mean vascular CIMT age was significantly higher than coronary calcium age (61.6 ± 11.4 vs 58.3 ± 11.1 years, P = .001), and both were significantly higher than chronologic age (56.9 ± 10.1 years) (P < .0001 and P < .04, respectively). CIMT upgraded or downgraded FRS by >5% in more cases than CAC (42% vs 17%). Conclusion: In asymptomatic patients without CV disease, CIMT and plaque assessment are more likely to revise FRS than CAC. Body mass index predicts increased CIMT in low-FRS subjects. These findings may have broad implications for screening in low-FRS subjects.

KW - Atherosclerosis

KW - Coronary calcium score

KW - Imaging

KW - Intima media thickness

KW - Plaque

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