Abstract 3840: The Performance of Subclinical Atherosclerosis as Screening Test for Coronary Heart Disease
Introduction Despite their etiologic importance, risk factors are inaccurate to predict coronary heart disease (CHD) as attested by 80% overlap existing in their distribution in subjects who died from CHD and in those who did not.
Hypothesis Testing existing arterial disease, even sub-clinical, may represent a new opportunity for more accurate CHD risk prediction.
Methods From published prospective population-based studies (Figure⇓), we calculated yearly incidence of CHD subsequent to sub-clinical atherosclerosis detection by several non-invasive markers: carotid intimamedia thickness (CIMT) or plaque assessed by ultrasound, coronary calcium assessed by computed tomography, aortic pulse wave velocity (PWV) assessed by mechanographic recordings of carotid and femoral pulses, or ankle arm index pressure (AAI) assessed by Doppler measurement of tibial systolic pressure.
Results A dose-response relationship was obtained between extent of subclinical disease and yearly CHD incidence, that was below 1% in the absence of disease tested by any above marker, and increased gradually above 1% with increasing atherosclerosis burden until a maximum of 3% in presence of high coronary calcium (Figure⇓). The relation between clinical disease such as angina, transient ischemic attack (TIA), stroke or myocardial infarct (MI), and corresponding yearly CHD incidence reported in the literature in the absence of modern treatment, prolonged the dose-response curve of sub-clinical disease. Comments Presence and extent of arterial disease, even at the subclinical stage, is a worthwhile screening test for future CHD event.