Ultrasound carotid artery intima-media thickness assessment for progression of atherosclerosis in lipid intervention studies

Atherosclerotic cardiovascular disease is the number one cause of death in Western countries and is a rapidly growing problem worldwide. The majority of patients who present with acute coronary syndrome often have a low cardiovascular risk score, which is insufficient to warrant treatment prior to an acute coronary event. Alternatively, some high risk individuals never develop cardiovascular events. Identification of individuals who are truly at risk before an acute coronary event is critical. The long subclinical incubation period of atherosclerosis and the early involvement of the vessel wall in the disease provides an opportunity to evaluate the presence of atherosclerosis by imaging the arterial wall and to initiate treatment measures prior to an acute coronary event. The assessment of the thickness of the intima-media layer of the vessel wall, as well as detection of early plaques by ultrasound, is non-invasive and is the most sensitive, reliable, and safe method to detect those at risk. It is also the most validated method to detect progression of atherosclerosis. Evaluation of atherosclerosis progression by this technique has been used in large clinical trial settings, however, improvement in imaging and measurement technology may make this suitable for use in individual patients for therapeutic validity both in primary and secondary care settings.