Ultrasound May Detect Atherosclerotic Disease Before Symptoms

Ultrasound of bilateral iliofemoral arteries may detect plaques in peripheral arteries before the appearance of symptoms of atherosclerotic disease, according to an article published in the journal, Global Heart.

Researchers from India, the United States, and Canada sought to assess subclinical atherosclerotic cardiovascular disease (ASCVD) using B-mode ultrasound, particularly the incremental value of performing imaging in multiple peripheral arteries. This was compared with imaging findings with traditional risk factors for medical intervention eligibility.

Four cohorts, two asymptomatic from India and two with known ASCVD risk factors from North America were included in the study. In India, radiology residents trained to perform ultrasounds screened 941 subjects (34% female), mean age 44, over the course of eight days. The cohorts were targeted because of the subjects’ aggressive lifestyle changes, which included smoking cessation, no alcohol or meat consumption, physical activity, and daily meditation.

The North American cohorts comprised 481 subjects (39% female), mean age 60. Data collected included cholesterol levels, blood pressure, glucose level, weight, height, smoking, and family history.

Of the 994 subjects in the Indian cohort, 224 (24%) were found to have plaques in at least one of four arterial sites examined:

The researchers found that being older and male was associated with the presence of plaque.

Of the 481 North American cohorts, 203 (42%) showed plaque in the carotids. The authors noted that 166 subjects in this group (82%) would not have qualified for lipid-lowering therapy under the Adult Treatment Panel (ATP) III Guidelines. However, if the recently published ATP IV guidelines were followed, 67 subjects (33%) in this group would also not qualify for lipid-lowering therapy.

 “B-mode ultrasound examination of bilateral iliofemoral arteries provided an incremental yield in identifying subclinical atherosclerotic disease compared to carotid evaluation alone,” the researchers concluded. Using ultrasound examination helped clinicians identify individuals who could be targeted for prophylactic medical intervention compared to ATP III and ATP IV Guidelines.

"This study shows that the assessment of subclinical atherosclerosis by a portable, user-friendly bedside tool is feasible in large populations and the technique of carotid ultrasound imaging and IMT assessment could be adopted by novices after an 8-hour crash course," Tasneem Z. Naqvi, MD, professor of medicine at the Mayo College of Medicine and Division of Cardiology, Scottsdale, AZ, wrote in an accompanying editorial.