Abstract 9771: Aggressive Treatment of Cardiovascular Risk Factors: Effects on Atherosclerosis and Arterial Age

Abstract

Background: Atherosclerosis, the major cause of cardiovascular disease (CVD), involves the abnormal deposit of cholesterol within the intima of the arterial wall. Arteriosclerosis is the annual thickening (roughly 0.01 mm per year) of the arterial wall (media) based generally on aging. An indirect method of diagnosing atherosclerosis involves ultrasound analysis of the common carotid intima-media wall thickness (CCIMT) to evaluate a patient's arterial age. Arterial age is a term representing the combination of wall thickness based both on atherosclerosis and arteriosclerosis.

Hypothesis: Aggressively treating CVD risk factors will reduce atherosclerosis and arterial age as measured by CCIMT analysis.

Methods: An observational study of 220 patients (121 m, mean age 58 yrs) treated in a CVD prevention clinic and with at least 1 CVD risk factor. Two ultrasounds were performed by the same sonographer, approximately 3 years apart, with a computerized edge-detection device (MICROMAXX, Sonosite) measuring 100 markers within 1 cm area of the CCIMT wall, 1 cm proximal to the bulb, to provide the maximum thickness. Arterial age was estimated based on data of previous epidemiology studies stored within the MICROMAXX.

Results: After a mean follow up of 3.05 years, the observed values for maximum CCIMT (see table) were significantly lower (p<0.0001) than expected. While patients' chronological age increased by 3 years, their arterial age decreased by 1.53 years (p<0.0001), translating into a 4.57 year difference compared to the expected change. Reduction of total cholesterol was the only risk factor found to be significantly associated with reduction in vascular age (p<.027).

Conclusion: In patients with CVD risk factors, aggressive clinical treatment resulted in statistically significant reductions in the rate of maximum CCIMT progression and reversing arterial age. Longer follow-up is needed to determine if these findings also translate to fewer clinical events.