Key result
Preclinical atherosclerosis significantly increased the 20-year risk of cardiovascular events compared to normal carotid arteries (54.1% vs 31.8%), with the highest risk observed in patients who also had metabolic syndrome.
Why the study?
Does the presence of preclinical atherosclerosis and metabolic syndrome increase the rate of cardio- and cerebrovascular events in asymptomatic patients?
Cohort (n=529)
No
Does the presence of preclinical atherosclerosis and metabolic syndrome increase the rate of cardio- and cerebrovascular events in asymptomatic patients?
Preclinical atherosclerosis, especially when combined with metabolic syndrome, significantly increases the long-term risk of cardiovascular and cerebrovascular events in asymptomatic individuals.
May support closer monitoring in asymptomatic patients with preclinical atherosclerosis and metabolic syndrome; leaves open whether interventions improve long-term outcomes.
BACKGROUND: Intima-media thickness (IMT) is a validated marker of preclinical atherosclerosis and a predictor of cardiovascular events. PATIENTS: We studied a population of 529 asymptomatic patients (age 62 ± 12.8 years), divided into two groups of subjects with and without Metabolic Syndrome (MetS). METHODS: All patients, at baseline, have had a carotid ultrasound evaluation and classified in two subgroups: the first one without atherosclerotic lesions and the second one with preclinical atherosclerosis (increased IMT or asymptomatic carotid plaque). Cardiovascular endpoints were investigated in a 20-years follow-up. RESULTS: There were 242 cardiovascular events: 144 among patients with MetS and 98 among in healthy controls (57.4% vs. 35.2%; P < 0.0001). 63 events occurred in patients with normal carotid arteries, while 179 events occurred in patients with preclinical atherosclerosis (31.8% vs. 54.1%; P < 0.0001). Of the 144 total events occurred in patients with MetS, 36 happened in the subgroup with normal carotid arteries and 108 in the subgroup with preclinical atherosclerosis (45% vs. 63.15%; P = 0.009). 98 events occurred in patients without MetS, of which 27 in the subgroup with normal carotid arteries and 71 in the subgroup with preclinical atherosclerosis (22.88% vs. 44.37%; P = 0.0003). In addition, considering the 63 total events occurred in patients without atherosclerotic lesions, 36 events were recorded in the subgroup with MetS and 27 events in the subgroup without MetS (45% vs. 22.88%; P = 0.0019). Finally, in 179 total events recorded in patients with preclinical carotid atherosclerosis, 108 happened in the subgroup with MetS and 71 happened in the subgroup without MetS (63.15% vs. 44.37%; P = 0.0009). The Kaplan-Meier function showed an improved survival in patients without atherosclerotic lesions compared with patients with carotid ultrasound alterations (P = 0.01, HR: 0.7366, CI: 0.5479 to 0.9904). CONCLUSIONS: Preclinical atherosclerosis leads to an increased risk of cardiovascular events, especially if it is associated with MetS.
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Novo et al. (2013) conducted a cohort in Asymptomatic adults (n=529). Preclinical atherosclerosis vs. Normal carotid arteries was evaluated on Cardiovascular events (AMI, angina pectoris, TIA, ischemic stroke, AAA, TEA, and cardiovascular death) (HR 0.7366, 95% CI 0.5479-0.9904, p=0.0159). Preclinical atherosclerosis significantly increased the 20-year risk of cardiovascular events compared to normal carotid arteries (54.1% vs 31.8%), with the highest risk observed in patients who also had metabolic syndrome.
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