Abstract 14219: Mass Screening for Atherosclerosis by Carotid Ultrasound Examination: The Heart Attack Prevention Program for You by Arterial Screen for Atherosclerosis Prediction (HAPPY ASAP) Study
Background: Epidemiological transition has resulted in accelerated prevalence rate of cardiometabolic disease with early age of onset and greater mortality. We performed a population based cross-sectional study using an automated carotid ultrasound screening device for investigating the prevalence and age-specific distribution in carotid intima-media thickness (CIMT) and carotid plaque as an index of subclinical atherosclerosis.
Methods: We assessed CIMT and carotid plaques in 771 asymptomatic volunteers (40 ±14 years) with unknown prior cardiovascular disease. Fully automated CIMT measurements were recorded using a single transducer angle and defined as the mean of 24 spatial measurements performed over a 1cm region in the far wall of the common carotid artery. Atherosclerotic plaque was defined as any obvious focal luminal encroachment >1.5mm. Medical volunteers gathered all CIMT data; the automated functions built into the ultrasound instrument obviated the need for qualified sonographers or physicians to interpret the images.
Results: Global mean CIMT was 0.55 ± 0.13 mm. CIMT values correlated with age for both left (r=0.61, P<0.001) and right (r=0.60, P<0.001) carotid arteries in male subjects (n= 626). The corresponding correlation between age and CIMT for left (r=0.70, p<0.001) and right (r=0.67, p<0.001) carotid arteries was slightly better in females (n=145). Atherosclerotic plaques were seen in 69 (8.9%) subjects, with bilateral plaques seen in 16 (2.1%) cases, left carotid plaques seen in 28 (3.6%) cases and right carotid plaques seen in 25 (3.2%) cases respectively. Of the 69 subjects found to have plaques, only 3 (4.3%) were self-reported smokers, with none reporting consumption of alcohol or meat products.
Conclusion: Mass screening of traditional risk factors for cardiovascular diseases in remote communities can be enhanced with carotid ultrasound equipment that does not require expertise in image acquisition or interpretation. Incidental findings of carotid plaques and elevation in CIMT despite low prevalence of traditional risk factors provide compelling reasons in developing aggressive screening strategies for subclinical atherosclerosis, starting as early as 30 years for developing nations like India.
- © 2012 by American Heart Association, Inc.