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Anokye R, Via JD, Dimmock J, Jackson B, Schultz C, Schæffer M, Dickson JM, Blekkenhorst LC, Stanley M, Hodgson JM, Lewis JR. Impact of Cardiovascular Imaging Results on Medication Use and Adherence: A Systematic Review and Meta-Analysis. Am J Prev Med 2024:S0749-3797(24)00193-4. [PMID: 38876293 DOI: 10.1016/j.amepre.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Cardiovascular imaging results offer valuable information that can guide health decisions, but their impact on medication use and adherence is unclear. This systematic review and meta-analysis aimed to determine the downstream impact of cardiovascular imaging results on medication use and adherence. METHODS Searches were conducted across databases, including MEDLINE, PsychINFO, EMBASE, and relevant references up to 2024. Data were extracted from studies comparing outcomes for individuals with diseased versus normal arteries and trials comparing outcomes for individuals who were provided imaging results versus those with no access to imaging results and analysed in 2023 and 2024. Pooled odds ratios (ORs) for outcomes were calculated. RESULTS The analysis included 29 studies with 24 contributing data points. Initiation (OR:2.77;95% CI:1.82-4.20) and continuation (OR:2.06;95% CI:1.28-3.30) of lipid-lowering medications (LLMs), antihypertensives (OR:2.02;95% CI:1.76-2.33), and antiplatelets (OR:2.47;95% CI:1.68-3.64) were significantly higher in individuals with diseased arteries. The proportion of individuals on LLM increased by 2.7-fold in those with diseased arteries and 1.5-fold in those with normal arteries post-screening. The proportion on LLM increased by 4.2 times in the imaging group and 2.2 times in the "no imaging group" post-screening. There was a significant increase in LLM initiation (OR:2.37;95% CI: 1.17-4.79) in the imaging group, but medication continuation did not significantly differ between the imaging and "no imaging group". DISCUSSION Cardiovascular imaging results can prompt initiation of medications, particularly lipid-lowering medications, reflecting a proactive response to identified risk factors. However, evidence regarding medication continuation is mixed, and further research is required.
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Affiliation(s)
- Reindolf Anokye
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.
| | - Jack Dalla Via
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
| | - James Dimmock
- Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ben Jackson
- Telethon Kids Institute, Perth, Western Australia, Australia; School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Carl Schultz
- Cardiology Department, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Mie Schæffer
- Department of Cardiology, Odense University Hospital, Denmark
| | - Joanne M Dickson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia; School of Arts and Humanities (Psychology Discipline), Edith Cowan University, Joondalup, Western Australia, Australia; Department of Psychological Science, University of Liverpool, UK
| | - Lauren C Blekkenhorst
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Mandy Stanley
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Jonathan M Hodgson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Atherosclerotic coronary artery disease: The accuracy of measures to diagnose preclinical atherosclerosis. Exp Ther Med 2016; 12:2899-2902. [PMID: 27882093 PMCID: PMC5103722 DOI: 10.3892/etm.2016.3710] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/28/2016] [Indexed: 01/21/2023] Open
Abstract
Different methods can be used to diagnose early pre-clinical stage atherosclerosis. The present study was carried out to evaluate the efficiency of these methods. Measures including carotid intima-media thickness (CIMT), pulse wave velocity (PWV), and coronary calcium score (CCS) were evalutated for the detection of coronary artery disease (CAD). We studied the clinical and biochemical profiles of individuals with non-CAD and CAD to assess measures of pre-clinical atherosclerosis. The association between CIMT, PWV and CCS on the one hand, and the coronary atherosclerosis on the other, was studied. In total, 150 cases of cardiovascular disease (CVD) participated in the present study and were subjected to computed tomographic (CT) coronary angiography to divide them into non-CAD (n=100) and CAD (n=50) groups. The patients were also subjected to pre-clinical atherosclerosis tests (CIMT, PWV and CCS). CAD patients had higher CIMT values on both sides (right side, 0.74±0.09 vs. 0.62±0.12 mm; left side, 0.78±0.16 vs. 0.64±0.19 mm; and average, 0.76±0.12 vs. 0.63±0.14 mm; all P-values <0.01). These patients also had significantly higher brachial-ankle PWV (baPWV) on left side (1638.8±372.9 vs. 1498.6±339.8 cm/sec, P<0.001). The overall CCS was significantly increased in CAD patients as compared to the patients without CAD (117.8±118.6 vs. 8.6±18.3, P<0.001). In conclusion, the present study showed that among different measures of preclinical atherosclerosis, CCS had the best diagnostic accuracy. However, the combination of CIMT and baPWV had an excellent negative predictive value for atherosclerotic coronary vascular disease.
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Kasliwal RR, Bansal M, Desai N, Kotak B, Raza A, Vasnawala H, Kumar A. A Study to derive distribution of carotid intima media thickness and to determine its COrrelation with cardiovascular Risk factors in asymptomatic nationwidE Indian population (SCORE-India). Indian Heart J 2016; 68:821-827. [PMID: 27931554 PMCID: PMC5143805 DOI: 10.1016/j.ihj.2016.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/16/2016] [Accepted: 04/07/2016] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND There is presently no data to describe normal distribution of carotid intima-media thickness (CIMT), an established measure of subclinical atherosclerosis, in Indian subjects. METHODS In this multi-centric study, 1229 subjects with age ≥30 years and no previous cardiovascular disease (CVD) underwent CVD risk factor assessment and CIMT measurement. Mean far wall common carotid artery IMT was measured on both sides and averaged. RESULTS Mean age of the subjects was 48.0±12.0 years and 54.2% were men. CIMT measurement was feasible in 1157 subjects. Mean, median and 75th percentile values of CIMT for different age-groups were derived for men and women separately. There was a progressive increase in CIMT with increasing age (P<0.001) and men had higher CIMT values than women (0.608±0.12mm vs. 0.579±0.11mm, P<0.001). The CIMT values were also higher in diabetics (0.635±0.10mm) and hypertensives (0.624±0.10mm) as compared to non-diabetics (0.589±0.12mm, P<0.001) and non-hypertensives (0.592±0.12, P 0.02) respectively. Among continuous variables, age, systolic blood pressure and fasting blood glucose had strong to modest correlation with CIMT (Pearson's r 0.524, 0.282 and 0.192 respectively, all P values <0.001), whereas body mass index, diastolic blood pressure and serum triglycerides exhibited weak but still statistically significant relationship (Pearson's r 0.069, P 0.019; Pearson's r 0.065, P 0.026; and Pearson's r 0.094, P 0.001, respectively). CONCLUSIONS This is the first study to provide age- and gender-specific distribution of CIMT in Indian subjects free from CVD. This information should help facilitate further research and clinical work involving CIMT in India.
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Affiliation(s)
| | | | - Nagaraj Desai
- Department of Cardiology, JSS Hospital MG Road, Mysuru, India
| | - Bhavesh Kotak
- Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India
| | - Ammar Raza
- Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India
| | - Hardik Vasnawala
- Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India
| | - Amit Kumar
- Medical Affairs, AstraZeneca Pharma India Ltd., Bangalore, India
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Chandra KS, Bansal M, Nair T, Iyengar SS, Gupta R, Manchanda SC, Mohanan PP, Rao VD, Manjunath CN, Sawhney JPS, Sinha N, Pancholia AK, Mishra S, Kasliwal RR, Kumar S, Krishnan U, Kalra S, Misra A, Shrivastava U, Gulati S. Consensus statement on management of dyslipidemia in Indian subjects. Indian Heart J 2014; 66 Suppl 3:S1-51. [PMID: 25595144 PMCID: PMC4297876 DOI: 10.1016/j.ihj.2014.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- K Sarat Chandra
- Editor, Indian Heart Journal, Sr. Cardiologist, Indo US Superspeciality Hospital, Ameerpet, Hyderabad 500016, India
| | - Manish Bansal
- Senior Consultant e Cardiology, Medanta e The Medicity, Sector 38, Gurgaon, Haryana 122001, India
| | - Tiny Nair
- Head, Department of Cardiology, PRS Hospital, Trivandrum, Akashdeep, TC 17/881, Poojapura, Trivandrum, Kerala 695012, India
| | - S S Iyengar
- Sr. Consultant & HOD, Manipal Hospital, 133, JalaVayu Towers, NGEF Layout, Indira Nagar, Bangalore 560038, India
| | - Rajeev Gupta
- Head of Medicine and Director Research, Fortis Escorts Hospital, JLN Marg, Malviya Nagar, Jaipur 302017, India
| | | | - P P Mohanan
- Westfort H. Hospital, Poonkunnanm, Thrissur 680002, India
| | - V Dayasagar Rao
- Sr. Cardiologist, Krishna Institute of Medical Science, Minister Road, Secunderabad, India
| | - C N Manjunath
- Director, Prof & HOD, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bannerghatta Road, Bangalore 560 069, India
| | - J P S Sawhney
- MD DM FACC, Chairman Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Nakul Sinha
- Sr. Consultant & Chief Interventional Cardiologist, Sahara India Medical Institute, VirajKhand, Gomti Nagar, Lucknow, Uttar Pradesh 226010, India
| | - A K Pancholia
- Head, Department of Clinical and Preventive Cardiology and Research Centre Arihant Hospital, Indore, MP, India
| | - Sundeep Mishra
- Prof. of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ravi R Kasliwal
- Chairman, Clinical and Preventive Cardiology, Medanta e The Medicity, Sector 38, Gurgaon, Haryana 122001, India
| | - Saumitra Kumar
- Professor, Vivekanada Institute of Medical Sciences, Kolkata, India; Chief Co-ordinator, Academic Services (Cardiology), Narayana Hrudayalay, RTIICS, Kolkata, India; Consultant Cardiologist, Fortis Hospital, Kolkata, India
| | - Unni Krishnan
- Chief Endocrinologist & CEO, Chellaram Diabetes Institute, Pune 411021, India
| | - Sanjay Kalra
- Consultant Endocrinology, Bharti Hospital & BRIDE, Karnal, Haryana, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chirag Enclave, New Delhi, India
| | - Usha Shrivastava
- Head, Public Health, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), Diabetes Foundation (India), New Delhi, India
| | - Seema Gulati
- Head, Nutrition Research Group, Center for Nutrition & Metabolic Research (C-NET) & National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Chief Project Officer, Diabetes Foundation (India), C-6/57, Safdarjung Development Area, New Delhi 110 016, India
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Bonaca MP, Beckman JA. Primary Stroke Prevention: Medical Therapy Versus Revascularization. Interv Cardiol Clin 2014; 3:1-11. [PMID: 28582145 DOI: 10.1016/j.iccl.2013.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Asymptomatic carotid-artery atherosclerotic vascular disease identifies patients at heightened risk of major adverse cardiovascular events including ischemic stroke. Observational and registry analyses demonstrate that this risk extends beyond that attributable to carotid atherosclerosis itself and includes events manifesting in other vascular territories, such as myocardial infarction. However, randomized trials aimed specifically at treating carotid stenosis have shown benefit in terms of reducing ischemic stroke in appropriately selected patients. Therefore, the approach to primary prevention in patients with stable carotid disease must include a comprehensive strategy to reduce cerebrovascular-specific and overall cardiovascular risk through lifestyle changes and intensive medical therapies.
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Affiliation(s)
- Marc P Bonaca
- Vascular Medicine Section, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Joshua A Beckman
- Vascular Medicine Section, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Bansal M, Chandra KS. The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for cholesterol management and for cardiovascular risk stratification: a reappraisal. Indian Heart J 2014; 66:1-4. [PMID: 24581088 PMCID: PMC3946473 DOI: 10.1016/j.ihj.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Manish Bansal
- Consultant Cardiologist, Medanta - The Medicity, Gurgaon, India
| | - K Sarat Chandra
- Chief Cardiologist, Indo US Superspeciality Hospital, Hyderabad, India; Editor, Indian Heart Journal.
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Aldridge ME, Do K, Oo T, Naqvi TZ. Carotid Intima-Media Thickness and Plaque Assessment by Trained Medical Residents: Validation and Preliminary Testing of a Training Protocol. J Am Soc Echocardiogr 2013; 26:1457-64. [DOI: 10.1016/j.echo.2013.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Indexed: 11/15/2022]
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Hong SJ, Chang HJ, Song K, Hong GR, Park SW, Kang HJ, Kim EJ, Kim DS, Jeong MH. Impact of atherosclerosis detection by carotid ultrasound on physician behavior and risk-factor management in asymptomatic hypertensive subjects. Clin Cardiol 2013; 37:91-6. [PMID: 24193449 DOI: 10.1002/clc.22220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/15/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There are limited data regarding the impact of atherosclerosis detection by carotid ultrasound (CUS) on physician prevention efforts and risk-factor management for cardiovascular disease. HYPOTHESIS Atherosclerosis detection by CUS in asymptomatic hypertensive patients would lead to physician prevention efforts, including target low-density lipoprotein cholesterol (LDL-C) level and prescription. Also, it may improve risk-factor management. METHODS A total of 347 asymptomatic hypertensive subjects (age 61 ± 8 years, 189 men) were prospectively recruited from 22 hospitals. Prior to CUS, physicians were surveyed regarding target LDL-C level. After CUS, patients were classified into positive CUS (n = 182) and negative CUS (n = 165) groups based on CUS results. Physicians were resurveyed to assess whether the initial target LDL-C goals were changed. At 6 months, cardiovascular risk-factor modification status was reassessed. RESULTS The proportion of lowered target LDL-C levels was significantly larger in the positive CUS group than in the negative CUS group (52% vs 23%, P < 0.001). These results were observed even in subjects who had low and moderate risk according to National Cholesterol Education Program-Adult Treatment Panel III guidelines. Lipid-lowering agents were similarly added or switched to another class in both groups (7% in the positive CUS group vs 11% in the negative CUS group, P = 0.153). LDL-C was significantly decreased in the positive CUS group (Δ = -24 ± 38 mg/dL, P < 0.001), whereas it was not significantly decreased in the negative CUS group (Δ = -6 ± 31 mg/dL, P = 0.105). CONCLUSIONS Atherosclerosis detection by CUS lowered physicians' target LDL-C level and improved cardiovascular risk management in terms of LDL-C reduction.
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Affiliation(s)
- Sung-Jin Hong
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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Solomon MD, Tirupsur A, Hytopoulos E, Beggs M, Harrington DS, French C, Quertermous T. Clinical utility of a novel coronary heart disease risk-assessment test to further classify intermediate-risk patients. Clin Cardiol 2013; 36:621-7. [PMID: 23929798 PMCID: PMC4231217 DOI: 10.1002/clc.22185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 07/02/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Current coronary heart disease (CHD) risk assessments inadequately assess intermediate-risk patients, leaving many undertreated and vulnerable to heart attacks. A novel CHD risk-assessment (CHDRA) tool was developed for intermediate-risk stratification using biomarkers and established risk factors to significantly improve CHD risk discrimination. HYPOTHESIS Physicians will change their treatment plan in response to more information about a patient's CHD risk level provided by the CHDRA test. METHODS A Web-based survey of cardiology, internal medicine, family practice, and obstetrics/gynecology physicians (n = 206) was conducted to assess the CHDRA clinical impact. Each physician was shown 3 clinical vignettes representing community-based cohort participants randomly selected from 8 total vignettes. For each, the physicians assessed the individual's CHD risk and selected preferred therapies based on the individual's comorbidities, physical examination, and laboratory results. The individual's CHDRA score was then provided and the physicians were queried for changes to their initial treatment plans. RESULTS After obtaining the CHDRA result, 70% of the physician responses indicated a change to the patient's treatment plan. The revised lipid-management plans agreed more often (74.6% of the time) with the current Adult Treatment Panel III guidelines than did the original plans (57.6% of the time). Most physicians (71.3%) agreed with the statement that the CHDRA result provided information that would impact their current treatment decisions. CONCLUSIONS The CHDRA test provided additional information to which physicians responded by more often applying appropriate therapy and actions aligned with guidelines, thus demonstrating the clinical utility of the test.
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Affiliation(s)
- Matthew D. Solomon
- Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ahalya Tirupsur
- Stanford University School of Medicine, Stanford, California; Department of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Evangelos Hytopoulos
- Stanford University School of Medicine, Stanford, California; Department of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael Beggs
- Department of Product Development, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Douglas S. Harrington
- Clinical Laboratory, Keck School of Medicine, University of Southern California, Los Angeles, California
- Aviir Diagnostic Laboratories, Irvine, California; Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cynthia French
- Department of Product Development, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Thomas Quertermous
- Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
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Robertson CM, Gerry F, Fowkes R, Price JF. Carotid intima–media thickness and the prediction of vascular events. Vasc Med 2012; 17:239-48. [DOI: 10.1177/1358863x12445103] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Carotid intima–media thickness (cIMT) has received interest as a predictor of cardiovascular events in recent years. Use of cIMT in a clinical setting is limited by the variability in measurement and the lack of evidence for its use in clinical risk prediction. This review examines the major studies that have assessed the relationship between cIMT and cardiovascular event risk and discusses the current role of IMT in cardiovascular risk prediction.
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Affiliation(s)
| | - F Gerry
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - R Fowkes
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Jacqueline F Price
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Rodondi N, Auer R, de Bosset Sulzer V, Ghali WA, Cornuz J. Atherosclerosis screening by noninvasive imaging for cardiovascular prevention: a systematic review. J Gen Intern Med 2012; 27:220-31. [PMID: 21882076 PMCID: PMC3270245 DOI: 10.1007/s11606-011-1833-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 07/28/2011] [Accepted: 08/05/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Noninvasive imaging of atherosclerosis is being increasingly used in clinical practice, with some experts recommending to screen all healthy adults for atherosclerosis and some jurisdictions mandating insurance coverage for atherosclerosis screening. Data on the impact of such screening have not been systematically synthesized. OBJECTIVES We aimed to assess whether atherosclerosis screening improves cardiovascular risk factors (CVRF) and clinical outcomes. DESIGN This study is a systematic review. DATA SOURCES We searched MEDLINE and the Cochrane Clinical Trial Register without language restrictions. STUDY ELIGIBILITY CRITERIA We included studies examining the impact of atherosclerosis screening with noninvasive imaging (e.g., carotid ultrasound, coronary calcification) on CVRF, cardiovascular events, or mortality in adults without cardiovascular disease. RESULTS We identified four randomized controlled trials (RCT, n=709) and eight non-randomized studies comparing participants with evidence of atherosclerosis on screening to those without (n=2,994). In RCTs, atherosclerosis screening did not improve CVRF, but smoking cessation rates increased (18% vs. 6%, p=0.03) in one RCT. Non-randomized studies found improvements in several intermediate outcomes, such as increased motivation to change lifestyle and increased perception of cardiovascular risk. However, such data were conflicting and limited by the lack of a randomized control group. No studies examined the impact of screening on cardiovascular events or mortality. Heterogeneity in screening methods and studied outcomes did not permit pooling of results. CONCLUSION Available evidence about atherosclerosis screening is limited, with mixed results on CVRF control, increased smoking cessation in one RCT, and no data on cardiovascular events. Such screening should be validated by large clinical trials before widespread use.
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Affiliation(s)
- Nicolas Rodondi
- Department of General Internal Medicine, University of Bern, PKT 2, 0562, Lausanne, Switzerland.
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Johnson HM, Einerson J, Korcarz CE, Aeschlimann SE, Stein JH. Long-term effects of carotid screening on patient outcomes and behaviors. ACTA ACUST UNITED AC 2011; 171:589-91. [PMID: 21444853 DOI: 10.1001/archinternmed.2011.90] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Heather M Johnson
- Division of Cardiovascular Medicine, Atherosclerosis Imaging Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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Johnson HM, Turke TL, Grossklaus M, Dall T, Carimi S, Koenig LM, Aeschlimann SE, Korcarz CE, Stein JH. Effects of an office-based carotid ultrasound screening intervention. J Am Soc Echocardiogr 2011; 24:738-47. [PMID: 21477989 DOI: 10.1016/j.echo.2011.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Carotid ultrasound screening (CUS) has been recommended for cardiovascular disease risk prediction, but its effectiveness in clinical practice is unknown. The purpose of this study was to prospectively determine the effects of office-based CUS on physician decision making and patient health-related behaviors. METHODS Physicians from five nonacademic, community practices recruited patients aged ≥40 years with ≥1 cardiovascular disease risk factor. Abnormal results on CUS (AbnlCUS) were defined as carotid intima-media thickness >75th percentile or carotid plaque presence. Subjects completed questionnaires before and immediately after CUS and then 30 days later to determine self-reported behavioral changes. Odds ratios (ORs) for changes in physician management and patient health-related behaviors were determined from multivariate hierarchical logistic regression models. RESULTS There were 355 subjects (mean age, 53.6 ± 7.9 years; mean number of risk factors, 2.3 ± 0.9; 58% women); 266 (74.9%) had AbnlCUS. The presence of AbnlCUS altered physicians' prescription of aspirin (P < .001) and cholesterol medications (P < .001). Immediately after CUS, subjects reported increased ability to change health-related behaviors (P = .002), regardless of their test results. Subjects with AbnlCUS reported increased cardiovascular disease risk perception (OR, 4.14; P < .001) and intentions to exercise (OR, 2.28; P = .008), make dietary changes (OR, 2.95; P < .001), and quit smoking (OR, 4.98; P = .022). After 30 days, 34% increased exercise frequency and 37% reported weight loss, but these changes were not predicted by the CUS results. AbnlCUS modestly predicted reduced dietary sodium (OR, 1.45; P = .002) and increased fiber (OR, 1.55; P = .022) intake. CONCLUSIONS Finding abnormal results on CUS had major effects on physician but not patient behaviors.
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Affiliation(s)
- Heather M Johnson
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
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Eleid MF, Lester SJ, Wiedenbeck TL, Patel SD, Appleton CP, Nelson MR, Humphries J, Hurst RT. Carotid Ultrasound Identifies High Risk Subclinical Atherosclerosis in Adults with Low Framingham Risk Scores. J Am Soc Echocardiogr 2010; 23:802-8. [DOI: 10.1016/j.echo.2010.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Indexed: 10/19/2022]
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Ray A, Tamsma JT, Hovens MMC, op 't Roodt J, Huisman MV. Accuracy of carotid plaque detection and intima-media thickness measurement with ultrasonography in routine clinical practice. Eur J Intern Med 2010; 21:35-9. [PMID: 20122611 DOI: 10.1016/j.ejim.2009.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 09/20/2009] [Accepted: 10/01/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND Current guidelines in cardiovascular disease prevention advocate the use of carotid ultrasound measurements for risk stratification. Carotid abnormalities (plaques or increased intima-media thickness (IMT)) are associated with high risk of coronary and peripheral artery disease. An office-based measurement by clinicians would considerably broaden the clinical applicability of carotid ultrasound. In the present study we have assessed the accuracy of ultrasound detection of carotid plaques and intima-media thickness by trained internists in a routine outpatient setting. METHODS AND RESULTS Carotid ultrasound was performed in 112 vascular outpatients by internists, after a six-week training period. The internists' results were independently compared to the reference standard, consisting of carotid ultrasound performed in a specialized vascular laboratory. Sensitivity and specificity were calculated for plaque detection and IMT determination. The mean time required to perform the scans on the outpatient department was 7.3 min (range 4.5 to 16.7 min). A high level of accuracy for detecting plaques (sensitivity 78.5%; specificity 93.6%) was achieved. Identifying abnormal IMT had lower sensitivity but adequate specificity of 46.7% and 87.6%, respectively. CONCLUSIONS In conclusion, our findings demonstrate that clinicians can be trained well enough in six weeks to accurately and efficiently detect carotid plaques in an outpatient setting. IMT abnormalities were less accurately detected in the office-based approach and may require a specialized vascular laboratory.
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Affiliation(s)
- A Ray
- Section of Vascular Medicine, Department of General Internal Medicine & Endocrinology, Leiden University Medical Center, Leiden, The Netherlands.
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Screening for subclinical coronary artery disease measuring carotid intima media thickness. Am J Cardiol 2009; 104:1383-8. [PMID: 19892054 DOI: 10.1016/j.amjcard.2009.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 07/02/2009] [Accepted: 07/02/2009] [Indexed: 11/23/2022]
Abstract
Traditional coronary risk assessment is based on major cardiovascular risk factors using the Framingham risk score. Carotid intima-media thickness (CIMT) measured by ultrasonography is a noninvasive test used to assess for the presence of coronary atherosclerosis. CIMT has been shown to be an independent predictor of future cardiovascular events and is used in research trials as a surrogate for the presence as well as regression of coronary artery disease. The objectives of this report are to review the published reports on CIMT and to help establish the role of CIMT as a screening tool for coronary artery disease in selected patients. CIMT measurement can modify cardiovascular risk prediction in patients initially classified with the Framingham risk score, with reclassification into higher or lower risk categories. It is most useful for refining risk assessment in patients at intermediate risk. The Screening for Heart Attack Prevention and Education (SHAPE) Task Force recommends screening all asymptomatic middle-aged and older men and women using noninvasive imaging. The American Society of Echocardiography established a consensus on the methodologic aspects of CIMT measurement. Sequential scanning of CIMT to assess atherosclerosis is currently not recommended, because of interscan variability and small expected changes over time. In conclusion, in the primary prevention of coronary artery disease, CIMT measurement reclassifies patients into higher or lower risk categories, allowing early appropriate management.
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Affiliation(s)
- Prashant Kaul
- From the Division of Cardiovascular Medicine, and Duke Clinical Research Institute (P.K., P.S.D.); Duke University Medical Center, Durham, NC
| | - Pamela S. Douglas
- From the Division of Cardiovascular Medicine, and Duke Clinical Research Institute (P.K., P.S.D.); Duke University Medical Center, Durham, NC
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Stein JH, Korcarz CE, Post WS. Use of Carotid Ultrasound to Identify Subclinical Vascular Disease and Evaluate Cardiovascular Disease Risk: Summary and Discussion of the American Society of Echocardiography Consensus Statement. ACTA ACUST UNITED AC 2009; 12:34-8. [DOI: 10.1111/j.1751-7141.2008.00021.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Korcarz CE, DeCara JM, Hirsch AT, Mohler ER, Pogue B, Postley J, Tzou WS, Stein JH. Ultrasound detection of increased carotid intima-media thickness and carotid plaque in an office practice setting: does it affect physician behavior or patient motivation? J Am Soc Echocardiogr 2008; 21:1156-62. [PMID: 18558473 DOI: 10.1016/j.echo.2008.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this multicenter study was to determine if identifying increased carotid intima-media thickness (CIMT) or carotid plaque during office-based ultrasound screening examinations could alter physicians' treatment plans and patients' motivation regarding health-related behaviors. METHODS Carotid ultrasound studies were performed by a nonsonographer clinician using a handheld system. Changes in physicians' treatment plans and patients' motivation on the basis of scan results were analyzed using multivariate regression. RESULTS There were 253 subjects (mean age, 58.1 +/- 6.6 years). When increased CIMT or carotid plaque was detected, physicians were more likely to prescribe aspirin and lipid-lowering therapy (P < .001). Subjects were more likely to report increases in plans to take cholesterol-lowering medication (P = .002) and the perceived likelihood of having or developing heart disease (P = .004). CONCLUSIONS Findings from office-based carotid ultrasound studies can influence physicians' prescriptions of evidence-based interventions. Patients with abnormal ultrasound findings recognize their increased cardiovascular risk and plan to take cholesterol-lowering medication.
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Affiliation(s)
- Claudia E Korcarz
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Nanchen D, Cornuz J, Rodondi N, Bovet P. Carotid plaque screening as a motivational tool for healthy behavior. Am Heart J 2008; 155:e37-e39. [PMID: 18371458 DOI: 10.1016/j.ahj.2007.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 12/14/2007] [Indexed: 05/26/2023]
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Use of Carotid Ultrasound to Identify Subclinical Vascular Disease and Evaluate Cardiovascular Disease Risk: A Consensus Statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008; 21:93-111; quiz 189-90. [DOI: 10.1016/j.echo.2007.11.011] [Citation(s) in RCA: 1613] [Impact Index Per Article: 100.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Taylor AJ. Finding the pathway to improving patient outcomes with atherosclerosis imaging: who's motivated? Am Heart J 2007; 154:1008-10. [PMID: 18035068 DOI: 10.1016/j.ahj.2007.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 08/20/2007] [Indexed: 10/22/2022]
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