ECHO 2013 / The Role of Vascular Imaging in Cardiovascular Risk Assessment
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MCPT and Vascular Outcome
|
7 |
|
|
6 |
|
CI |
5 |
|
95% |
||
4 |
||
HRand |
2 |
|
|
3 |
1
0
MCPT
Stroke |
MI |
Vasc.Death |
N=72 |
N=50 |
N=58 |
2.8 |
2.5 |
|
1.5
Q75≥1.9 mm
Rundek T et al. Neurology 2008
Carotid Plaque and FRS in
NOMAS
•44% of subjects with low FRS had any plaque and they had 10-year risk of 18.3%
•12% of subjects with low FRS had plaque and MCPT ≥ 1.9 mm and a 10-year risk of 24.7%
• > 50% of low FRS and moderate FRS subjects could be reclassified
Rundek T et al. Neurology 2008
ARIC Results: CHD Incidence Rate
Nambi et al. JACC 2010;55:1600-7
Mathiesen E B et al. Stroke 2011;42:972-978
Back to Case 1
Carotid Duplex: Spectral Doppler
Back to Case 1
50 year old female
Hypertension
Current smoker
No DM
No known CAD
TC 212 HDL 57 LDL 126 TG 144
FRS 6%
Does the presence of plaque alter her risk assessment? Probably
Should the presence of plaque alter her risk management? Possibly
Does Awareness of Plaque Affect Patient
Behavior?
Smokers shown images of carotid plaques were more likely to stop smoking at 6 months
Quit Rates 22.2% versus 6%, p=0.003 in those who had plaque
Bovet P, et al. Prev Med 2002.
Patients more likely to adhere to diet and exercise recommendations after seeing pictures of plaque and report plans to take cholesterol-lowering meds
Korcarz C, et al. J Am Soc Echo 2008
The presence of plaque changed physician behavior. It increased patient perception of cardiovascular risk. It did not motivate patients to make lifestyle changes. Am Heart J 2007;154:1072-7.