Abstract
Background and Objective: The accurate assessment of the total cardiovascular risk (CVR) using risk calculation algorithms in individuals with CVR factors in the primary prevention setting is essential for optimal management decisions, including drug treatment initiation and treatment goals. The aim of this study was to evaluate the contribution of ultrasonographic identification of asymptomatic carotid atherosclerosis in the re-classification of the CVR assessed with the reference SCORE2/2-OP algorithm. Methods: In individuals aged ≥40 years without established cardiovascular disease, the 10-year CVR was calculated using the SCORE2/2-OP algorithm (3 risk categories: low/moderate, high, and very high). Carotid ultrasound study was applied using a portable handheld device (Lumify, Philips) to classify CVR as follows: (i) low/moderate (absence of atherosclerotic plaque), (i) high (atherosclerotic plaque with <50% stenosis), (iii) very high (atherosclerotic plaque with ≥50% stenosis). Results: Data from 332 participants were analysed [age 59±7.5 years, men 41%, current smokers 26%, body mass index 28±5 kg/m2, office blood pressure 125±15/77±10 mmHg (systolic/diastolic), LDL-cholesterol 111±33 mg/dl]. Based on SCORE2/2-OP, 49/46/5% participants were categorised as of low/moderate, high, and very high CVR, respectively. Based on carotid ultrasound, the rates were 39/59/2%, respectively. 44% of individuals categorized as of low/moderate CVR based on SCORE2/2-OP were re-classified into a higher CVR category based on carotid ultrasound. The agreement between the 2 methods (ultrasound versus algorithms) in categorizing low/moderate and high CVR was 67% (kappa 0.35, P<0.001) and 61% (kappa 0.23, P<0.001), respectively. Among 204 participants categorized as of high/very high CVR according to carotid ultrasound, only 15 (7%) had LDL-cholesterol levels <70 mg/dl. Conclusions: These findings suggest that carotid ultrasonography using a portable handheld device may significantly contribute to assess CVR more accurately in primary care, especially in individuals classified as of low/moderate CVR using reference algorithms.
Published Version
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