Abstract
Carotid atherosclerosis assessments inform about stroke and cardiovascular risk. It is known that stroke and cardiovascular disease (CVD) prevalence is higher in rural communities than in urban communities. We aimed to conduct a systematic review of rural carotid ultrasound screening programs to define carotid atherosclerosis using traditional and emerging imaging biomarkers, prevalence, and risk factors. We searched Ovid/MEDLINE, Ovid/EMBASE, SCOPUS and CINAHL from inception to 3 April 2020 for rural population studies that utilized carotid ultrasound screening for adults ≥40 years of age and free of known cerebrovascular disease. Studies were included if participants received a bilateral ultrasound scanning of the carotid arteries and reported at least one marker of carotid atherosclerosis pathology. A random effect meta-analyses calculated the estimated prevalence of carotid plaque. In total, 22/3461 articles that met all of the inclusion criteria were included. Studies reported increased intima media thickness (IMT), carotid plaque presence and carotid artery stenosis. There were no studies reporting on novel imaging markers, such as carotid stiffness, carotid plaque morphology or neovascularization. The overall random effect pooled prevalence of carotid plaque was 34.1% (95% CI, 33.6–35.0); the prevalence of increased IMT was 11.2–41.5%, and the prevalence of carotid artery stenosis was 0.4–16.0%. There is an absence of data necessary to understand the carotid atherosclerosis prevalence across global rural populations. Represented studies have focused on East Asian countries where a high burden of rural carotid artery disease has been reported. There is no rural evidence to guide the use of novel ultrasound carotid biomarkers such as stiffness or neovascularization.
Highlights
The evaluation of modifiable environmental risk factors is the traditional approach to predicting those that should be treated to prevent cardiovascular disease (CVD) outcomes [1]
A total of 11 articles reported on intima media thickness (IMT) [24,26,27,28,29,30,31,32,33,34,35], 11 reported on carotid plaque [24,25,31,32,36,37,38,39,40,41,42] and five reported on carotid stenosis [24,25,33,35,43]
Our search strategy did not yield any articles reporting on carotid stiffness or other carotid ultrasound parameters
Summary
The evaluation of modifiable environmental risk factors is the traditional approach to predicting those that should be treated to prevent cardiovascular disease (CVD) outcomes [1]. Ultrasonography is an accessible imaging modality that can be used to predict cardiovascular outcomes via the assessment of detectable carotid atherosclerotic plaque, increased intima media thickness (IMT) and carotid artery stenosis [5,6,7]. Besides these traditional ultrasound determinants, studies have demonstrated emerging ultrasound biomarkers (e.g., carotid stiffness, carotid plaque morphology and neovascularization) as risk factors for stroke and future cardiovascular outcomes [8,9]. It is of interest that The European Society for Vascular Surgery and the European Society of Cardiology have both developed a consensus recommendation for the evaluation of carotid plaque morphology in patients with asymptomatic carotid artery disease [13]
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