Summary:A new study shows that scanning for plaque formation in the carotid artery is a more reliable way to assess the risk of heart attack and stroke than conventional methods. Further, in the study, researchers found that special 3D vascular ultrasound was more effective in identifying plaque formation than conventional CT scans.
It is no secret that cardiovascular issues like heart attack and stroke are the leading causes of death. Similarly, it is well-established that these issues occur due to plaque buildup in arteries. However, sub-clinical plaque buildup remains largely unidentified, as it produces almost no signs and symptoms. However, that will change as researchers have devised a new way to detect early plaque, thus predicting mortality risk.
Plaque buildup occurs due to atherosclerosis, hardening of arteries, and accumulation of fats in the blood vessels or calcification, causing plaque formation. This plaque formation happens slowly over the years. There are numerous tests that may help predict the risk of this plaque formation, but most of them do not directly measure plaque formation.
Thus, chronic pain specialists would look for inflammation, measure blood pressure, test levels of various minerals, and check blood for lipid levels. All these tests help predict the risk of plaque formation, but they are not very precise, and moreover, there are huge individual differences.
Fortunately, diagnostics are also improving, and researchers are finding ways to track risk factors for plaque formation and directly measure plaque buildup in arteries. Such an approach is much more precise in predicting mortality risk due to cardiovascular events.
Of course, there are multiple ways of measuring plaque formation in arteries, and methods are improving. Doctors do not just measure plaque formation in any random artery. Measuring plaque formation in some arteries is more accessible and better at predicting the risk of cardiovascular events like heart attack and stroke. Thus, doctors more often measure plaque formation in carotid, relatively large, and superficial arteries. This large artery goes through the neck, making its 360-degree scanning relatively easier.
In a new study in the US, researchers evaluated 5,716 individuals with a mean age of 68.9 years. They were enrolled in the study between 2008 and 2009 for a study focused on understanding the burden of atherosclerosis. These individuals had no symptoms. They were tested for plaque buildup using vascular ultrasound to quantify carotid plaque burden (cPB) (the sum of right and left carotid plaque areas) and by computed tomography for coronary artery calcium (CAC).Out of all participants, 732 also underwent follow-up examination after a median of 8.9 years.
After an average of 12.4 years of follow-up, 901 (16%) of them died. Researchers found that both cPB and CAC were good at predicting the risk of premature death due to various reasons. However, they found that vascular ultrasound, or cPB, was superior to computer tomography-based CAC in predicting mortality risk.
So, there are a few interesting things about this study. It shows that instead of measuring indirect indicators or biomarkers of cardiovascular diseases, it may be better to measure subclinical plaque buildup, as this test is now becoming readily available in healthcare facilities like interventional pain management in St. Louis and is better at predicting mortality risk.
Additionally, this study found that special 3D vascular ultrasound was better for measuring plaque formation than computer tomography. Ultrasound is not only safer; it is relatively easier to carry out. Of course, this is not your regular ultrasound but a special 3D vascular ultrasound.
Experts say there are a few reasons why these new methods are better for predicting mortality risk. For example, a lipid profile is good for predicting risk, but most patients with elevated lipids are on aggressive lipid LDL-cholesterol lowering therapy.
There is also a reason why ultrasound is better than a CT scan for measuring calcification in carotid arteries. CT appears to be good for measuring calcified plaques, while ultrasound is also good for identifying noncalcified plaques that precede the calcified or dense plaques. So, ultrasound can help better understand if things are getting better or the condition is progressing, which is especially vital when people are being treated for atherosclerosis.
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
