Early Detection of Subclinical Atherosclerosis in Asymptomatic Patients Assessed by Carotid Duplex and Coronary Computed Tomography

Abstract

Background: The objective of this study is to determine the presence of early-stage atherosclerosis and the determinants of those with abnormal intima-media thickness (IMT) without coronary calcification assessed by carotid duplex and coronary computed tomography in a relatively healthy population and to compare the results from the two detection methods. Materials and methods: Data of 181 asymptomatic participants [mean age 50.8 (35–72) years, 131 males] regarding baseline characteristics; blood biochemistries; Framingham risk score (FRS); metabolic score (MS); either carotid intima-media thickness (CIMT) or plaque, or both; and coronary artery calcification score (CACS) were obtained. Distributional differences between categorized atherosclerosis groups defined by various methods were compared using Chi-square test, while uni- and multivariate analyses were conducted to establish independent risk of atherosclerosis. Results: For all participants, the mean MS was 1.58 and mean FRS was 5.99. Zero CACS was found in 123 individuals, of whom 75 (61%) had abnormal CIMT or plaque existence. After adjusting the confounders, both male gender and larger BMI were found to be significantly associated with abnormal CIMT or plaque existence in patients with zero CACS in multivariable regression model. Conclusion: Carotid duplex may detect subclinical vascular atherosclerosis in more than half of asymptomatic patients without coronary artery calcification detected by coronary computed tomography. These findings have important implications for early-stage atherosclerosis screening and implementation of primary preventive intervention.

Keywords

• cardiovascular disease
• carotid intima-media thickness
• computed tomography
• coronary artery calcium score
• Framingham risk score