Key result
Four-site superficial arterial ultrasound effectively reclassifies cardiovascular disease risk in a rapid assessment.
Why the study?
Ascertaining plaque presence in four superficial arterial bifurcations with ultrasound is inexpensive and less time-consuming than measuring plaque thickness, area, or volume, offering potential for practical clinical application.
Does the number of carotid and common femoral bifurcations with plaque detected by ultrasound improve ASCVD risk reclassification beyond SCORE2 and SCORE2-OP algorithms in individuals free from ASCVD and diabetes?
Cohort (n=908)
Does the number of carotid and common femoral bifurcations with plaque detected by ultrasound improve ASCVD risk reclassification beyond SCORE2 and SCORE2-OP algorithms in individuals free from ASCVD and diabetes?
Ultrasound detection of plaque in carotid and femoral bifurcations significantly improves ASCVD risk reclassification beyond standard SCORE algorithms.
Answers are grounded in this paper and cite their sources.
May enable simpler ultrasound plaque screening for risk assessment; hypothesis-generating and requires prospective validation.
BACKGROUND: The aim was to determine the efficacy of the number of carotid and common femoral bifurcations with plaque (NBP) detected by ultrasound in reclassifying individuals into atherosclerotic cardiovascular disease (ASCVD) risk categories based on SCORE2, SCORE2-OP algorithms and age. Data from the cohort of 908 individuals free from ASCVD and diabetes in the Cyprus Epidemiological Study on Atherosclerosis (CESA) was used. METHODS: In each predicted ASCVD risk category (low to moderate, high and very high) the observed 10-year risk of subgroups according to the NBP was used to reclassify participants. RESULTS: There were 183 ASCVD events during a mean follow-up of 15.5±4.6 years. The observed 10-year event rate was 4% in the low to moderate risk category, 7% in the high-risk category and 21% in the very high-risk category. The presence of more than one bifurcation with plaque up-classified 41 (16%) participants from the low to moderate category to a high-risk group (observed 10-year risk of 12%) with adjusted to SCORE2 and SCORE2-OP hazard ratio of 5.21 (95% CI 2.18 to 17.69) and 130 (40%) participants from the high-risk category to a very high-risk group (observed 10-year risk of 17%) with hazard ratio of 4.52 (95% CI 2.35 to 8.69). CONCLUSIONS: Because ultrasound is relatively inexpensive, and because ascertaining the presence of plaque in four superficial arterial bifurcations is a much easier and less time-consuming method than measurements of plaque thickness, area, or volume, this method has the potential for a practical clinical application.
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Nicolaides et al. (2025) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) risk (n=908). Presence of more than one carotid and common femoral bifurcation with plaque vs. SCORE2 and SCORE2-OP algorithms alone (≤1 bifurcation with plaque) was evaluated on ASCVD events (up-classification from low/moderate to high risk) (HR 5.21, 95% CI 2.18 to 17.69). The presence of >1 bifurcation with plaque up-classified 16% of low/moderate-risk participants to high risk and 40% of high-risk to very high risk.
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