Summary:A new study shows that scanning for plaque in the carotid artery (the big artery in your neck) predicts heart attack and stroke better than the usual methods. The study also found that a special 3D vascular ultrasound spotted plaque better than standard CT scans.
It is no secret that heart attack and stroke are the leading causes of death. It is also well known that they come from plaque building up in the arteries. But early plaque mostly goes unnoticed, because it causes almost no signs or symptoms. That is about to change. Researchers have found a new way to spot early plaque and predict the risk of death.
Plaque comes from atherosclerosis. Arteries harden, and fat and calcium pile up in the vessel walls. This happens slowly over years. Many tests help predict the risk of plaque. But most of them do not measure the plaque itself.
So chronic pain specialists would check for inflammation, measure blood pressure, test mineral levels, and check blood fats. All these tests help predict plaque risk. But they are not very precise. And people differ a lot from one another.
The good news is that testing is improving. Researchers are finding ways to track plaque risk factors and measure plaque in the arteries directly. That predicts the risk of death from heart attack and stroke much more precisely.
There are many ways to measure plaque in arteries, and they keep improving. Doctors do not measure plaque in just any artery. Some arteries are easier to reach and better at predicting heart attack and stroke. So doctors most often measure plaque in the carotid arteries. These are fairly large arteries close to the surface. The carotid runs through the neck, so a full 360-degree scan is fairly easy.
In a new US study, researchers looked at 5,716 people with an average age of 68.9 years. They joined the study between 2008 and 2009. The study’s goal was to understand how much atherosclerosis people carry. None of them had symptoms. They were tested for plaque two ways. A vascular ultrasound measured carotid plaque burden (cPB) (the sum of right and left carotid plaque areas). A CT scan measured coronary artery calcium (CAC).Of all the people, 732 also had a follow-up exam after a median of 8.9 years.
After an average of 12.4 years of follow-up, 901 (16%) of them had died. Both cPB and CAC predicted the risk of early death from many causes. But vascular ultrasound, or cPB, beat CT-based CAC at predicting the risk of death.
So this study shows a few interesting things. Instead of measuring indirect signs of heart disease, it may be better to measure early plaque itself. This test is now easy to get at places like interventional pain management in St. Louis. And it is better at predicting the risk of death.
This study also found that a special 3D vascular ultrasound measured plaque better than a CT scan. Ultrasound is safer. It is also easier to do. Keep in mind, this is not your regular ultrasound. It is a special 3D vascular ultrasound.
Experts say there are a few reasons these new methods predict death risk better. For example, a cholesterol panel is good for predicting risk. But most patients with high blood fats are already on strong LDL-cholesterol-lowering drugs.
There is also a reason ultrasound beats a CT scan for the carotid arteries. CT is good at measuring hard, calcified plaque. Ultrasound can also find soft, noncalcified plaque, which forms before the hard kind. So ultrasound can better show whether things are getting better or worse. That matters most when people are being treated for atherosclerosis.
Frequently asked questions
What are the signs of plaque in the arteries?
Early plaque usually has none. Early plaque causes almost no signs or symptoms, which is why it mostly goes unnoticed. In this study, all 5,716 people scanned had no symptoms. Yet the amount of plaque in their arteries still predicted who was more likely to die over the following years.
How long does it take for plaque to build up in the arteries?
Years. Plaque forms slowly as arteries harden and fat and calcium pile up in the vessel walls. It builds slowly and silently. So measuring the plaque itself gives a clearer picture of risk than waiting for symptoms. It also beats relying only on indirect markers like blood pressure, inflammation or blood fats.
How do doctors test for plaque in the arteries?
This study compared two direct tests. One was a special 3D vascular ultrasound of the carotid arteries, which measures carotid plaque burden. The other was a CT scan that scores coronary artery calcium. Both predicted the risk of early death. But the carotid ultrasound did it better. This is not a regular ultrasound. It scans the artery in 3D.
Is an ultrasound or a CT scan better for finding plaque?
In this study, the 3D ultrasound was better. CT is good at spotting hard, calcified plaque. Ultrasound also picks up the soft plaque that forms before the hard kind. Ultrasound is also safer and easier to do. And it shows whether plaque is shrinking or growing. That matters for anyone being treated for atherosclerosis.
Why do doctors scan the carotid artery for plaque?
The carotid is a fairly large artery that runs close to the surface of the neck. So it is easy to scan all the way around, a full 360 degrees. Plaque in some arteries predicts heart attack and stroke better than in others. The carotid is one of the most practical and reliable places to look.
Source:
Fuster, V., García-Álvarez, A., Devesa, A., Mass, V., Owen, R., Quesada, A., Fuster, J. J., García-Lunar, I., Pocock, S., Sánchez-González, J., Sartori, S., Peyra, C., Andres, V., Muntendam, P., & Ibanez, B. (2024). Influence of Subclinical Atherosclerosis Burden and Progression on Mortality. Journal of the American College of Cardiology, 84(15), 1391–1403. https://doi.org/10.1016/j.jacc.2024.06.045
Dr. Gurpreet Singh Padda, MD, MBA, MHP
