Detecting Subclinical Coronary and Carotid Atherosclerosis in Asymptomatic Adults | Journal Scan

Study Questions:

To what degree do imaging biomarkers including coronary artery calcification (CAC) and 3-D carotid ultrasound (US) derived plaque burden predict near-term (3-year) atherothrombotic events?


The BioImage study enrolled 5,808 asymptomatic US adult men ages 55-80 years and women 60-80 years free from cardiovascular disease in a prospective cohort. All patients were evaluated by CAC score and novel 3-D carotid US. Plaque areas from both carotid arteries were summed as the carotid plaque burden (cPB). The primary endpoint was the composite of major adverse cardiac events (MACE; cardiovascular death, myocardial infarction [MI], and ischemic stroke).


Mean age was 69 years and 56.5% were female. Over a median follow-up of 2.7 years, there were 82 primary MACE events (1.5%). After adjustment for risk factors, and compared to individuals without any cPB, hazard ratios (95% CI) for MACE were 0.78 (0.31-1.91), 1.45 (0.67-3.14), and 2.36 (1.13-4.92) with increasing cPB tertile, with similar results for CAC. Net reclassification significantly improved with either cPB (0.23) or CAC (0.25). MACE rates increased simultaneously with higher levels of both cPB and CAC.


Detection of subclinical carotid or coronary atherosclerosis improves risk predictions and reclassification compared to conventional risk factors, with comparable results for either modality. Cost-effective analyses are warranted to define the optimal roles of these complementary techniques.


The CAC score is easily obtained, intra-individual values are relatively reproducible, and it is highly predictive of cardiovascular outcomes independent of cardiovascular risk factors and predictive models. The relative value of adding 3-D or other vascular US studies that are more technically demanding needs to be assessed. The MESA study suggested not to do so.

Clinical Topics: Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Echocardiography/Ultrasound

Keywords: Biological Markers, Cardiovascular Diseases, Coronary Artery Disease, Carotid Arteries, Plaque, Atherosclerotic, Atherosclerosis, Risk, Risk Factors, Ultrasonography, Doppler, Diagnostic Imaging

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