Comparison of Traditional and Novel Markers of Subclinical Atherosclerosis for Evaluating Cardiovascular Risk in Asymptomatic Population

Background: There is a definite need to identify markers that could offer greater discrimination of high- and low-risk patients within the general population at risk of cardiovascular disease (CVD). We tried to estimate the cardiovascular (CV) risk using novel imaging markers and compared them with traditional risk scores and biochemical markers. The study aimed at (1) evaluating the estimation of anthropometric, biochemical measurements (body surface area, body mass index, and lipid profile) along with novel imaging markers carotid intima-media thickness test (CIMT) and epicardial adipose tissue (EAT) for subclinical atherosclerosis carotid-femoral pulse wave velocity (CFPWV) for vascular stiffness; (2) comparing anthropometric markers, biochemical markers, and imaging markers in the study population with clinical risk prediction algorithms (American College of Cardiology/American Heart Association [ACC/AHA] atherosclerotic CVD [ASCVD] Risk Calculator). Materials and Methods: This was a prospective cross-sectional study done at a tertiary-level cardiac facility for a duration of 3 months. The study population consisted of apparently healthy individuals between the age group of 40 and 65 years. Persons with established ASCVD, chronic liver disease, chronic kidney disease, history of diabetes mellitus, or hypertension >7 years were excluded from the study. Results: Two hundred and seventy-seven individuals were included and divided into two groups based on the ACC/AHA ASCVD Risk Calculator. Individuals with <5% risk of ASCVD death/myocardial infarction/stroke over 10 years were included in low-risk group while individuals with 5%–15% risk of ASCVD death/myocardial infarction/stroke over 10 years were included in moderate-risk group. The relationship of these imaging parameters with ACC/AHA risk score was 8%, 16%, and 30% for CIMT, EAT, and CFPWV, respectively, whereas for total cholesterol/high-density lipoprotein (TC/HDL) ratio, it was 13% meaning that CIMT and TC/HDL ratio have weak correlation as compared to EAT and CFPWV. Inter-marker correlation with ACC/AHA Risk Calculator was 30% ( P < 0.0001) for CFPWV, 16% ( P = 0.008) for EAT, 13% ( P = 0.026) for TC/HDL ratio, and 8% ( P = 0.181) for CIMT. Multivariate regression showed that age, mean arterial blood pressure, history of diabetes mellitus, and EAT remain statistically significant parameters. Conclusion: Our study results suggested that both EAT and CFPWV measurements add incremental value over traditional methods for ASCVD risk stratification and should be of additional value over traditional methods for estimating ASCVD risk of an individual.