Plaque assessment as a potential cardiovascular risk modifier in primary care: A pilot study

Róbert Kiss-Kovács, Blanka Morvai-Illés, Ildikó Ambrus, Zsófia L. Somoskői, Albert Varga, Gergely Ágoston

Keywords: point-of-care ultrasound, plaque assessment, cardiovascular risk stratification

Background:

Cardiovascular diseases remain a leading cause of mortality worldwide, necessitating accurate risk stratification to enable early intervention. The SCORE2 algorithm is widely used to estimate cardiovascular risk, but it does not detect subclinical atherosclerosis.

Research questions:

This study explores the potential of detected plaque thickness with ultrasound to serve as a risk modifier, enhancing early detection and management of at-risk patients in primary care settings.

Method:

Point-of-care vascular ultrasound was used to assess plaque thickness in carotid and femoral arterial segments to calculate plaque score. High-sensitivity C-reactive protein (hsCRP) was measured with a point-of-care diagnostic device. All examinations were performed by a general practitioner, and the results were validated by an expert in cardiovascular ultrasonography.

Results:

A total of forty-two patients were enrolled (61.9% women) with a mean age of 53.8±10.9 years. Increased plaque scores may be associated with a higher cardiovascular risk, which may modify the value estimated by the ESC CVD risk calculator. Subsequently, 11.9% (n=5) of patients were reclassified according to carotid plaque score and 9.5% (n=4) according to femoral plaque score, using a cutoff score of >3 to discriminate high-risk patients. Notably, 11.9% of patients (n=5) had plaques detectable only in the femoral arterial system, including one patient who was initially in the low-risk group. Pearson correlation analysis revealed significant positive correlations between smoking status and femoral plaque score (r=0.439, p=0.004), and between cholesterol levels and both femoral (r=0.337, p=0.029) and carotid plaque scores (r=0.334, p=0.030). However, no significant correlation was observed between hsCRP levels and plaque scores.

Conclusions:

Integrating point-of-care vascular ultrasound to detect carotid and femoral plaques could potentially modify assessed risk, especially in patients initially classified as low or intermediate risk. This study suggests that plaque assessment can be a valuable tool in primary care, however further research with a larger cohort is warranted.

Points for discussion:

clinical relevance of plaque assessment in primary care

impact of plaque measurements on reclassification of cardiovascular risk

improvement of preventive care in general practice

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