Vascular ultrasound reclassified 68.3% of asymptomatic patients to very high cardiovascular risk due to multi-territory plaque involvement, impacting treatment targets.
Does vascular ultrasound reclassify cardiovascular risk in asymptomatic patients in primary prevention?
Vascular ultrasound frequently detects subclinical atherosclerosis in asymptomatic primary prevention patients, reclassifying a majority to very high cardiovascular risk and potentially altering lipid-lowering targets.
Absolute Event Rate: 0% vs 0%
Abstract European clinical practice guidelines on cardiovascular prevention highlight that atherosclerosis detection using vascular ultrasound (VUS) can be used as a cardiovascular risk-modifying factor. (1,2) However, there are no specific recommendations that consider the different scenarios according to specific findings regarding the number of plaques, location, or vulnerability characteristics, among others. The Spanish societies of Cardiology, Internal Medicine, Endocrinology, Nephrology, Neurology, General Practice, and Vascular Surgery have recently published a consensus proposing the use of vascular ultrasound (VUS) to detect subclinical atherosclerosis. In this regard, patients with "presence of 3-4 plaques, or disease in multiple territories" are classified as very high cardiovascular risk.(3) The objective of this study was to assess the impact of VUS on risk reclassification to very high risk category, based on this new multisociety consensus. It is based on a retrospective cohort of asymptomatic patients, with no history of cardiovascular events, who attended a primary prevention cardiology consultation. 3-years cases were included. Clinical data were obtained from electronic medical records, and SCORE-2 and SCORE-2OP risk scales were calculated. VUS data included the presence of plaque, number of plaques, and affected territories. Four territories were defined: right carotid, left carotid, right femoral, and left femoral arteries.(4) A total of 123 patients (60.3 ± 10.2 years; 53 (43%) women) were included (Table). The mean risk according to SCORE-2 and SCORE-2OP of the population was 4.5 ± 2.3%, with 74 (60.1%) patients at low-intermediate risk and 49 (39.8%) at high risk. VUS demonstrated the presence of plaques in 101 (82.1%) patients: 85 (69.1%) had carotid plaques and 81 (65%) femoral plaques (median of 3 1-4 plaques per patient). Following VUS and consensus criteria, a total of 84 (68.3%) patients were reclassified to very high risk, all due to involvement of 1 vascular territory (Figure). Therefore, the study population was divided into three groups: 22 (17.8%) patients at intermediate/low risk, 17 (13.8%) at high risk, and 84 (68.3%) at very high risk. Our study shows that the application of VUS results in a significant number of patients being reclassified to the very high-risk category. According to current guidelines, this would impact the therapeutic strategy for patients, aiming for more stringent LDL cholesterol targets (less than 55 mg/dl, and a reduction of ≤ 50% from baseline). In conclusion, our results highlight the potential use of VUS when assessing cardiovascular risk in a primary prevention scenario, according to the new multisociety consensus, with the consequent reclassification of most patients to the very high-risk category and the need for more aggressive treatments.Table Figure
Velasco et al. (Sat,) reported a other. Vascular ultrasound reclassified 68.3% of asymptomatic patients to very high cardiovascular risk due to multi-territory plaque involvement, impacting treatment targets.
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