Identifying individuals at risk for future cardiovascular events remains a challenge, and carotid ultrasound (CU) has been proposed as an adjunct to clinical guidelines for primary prevention. Although CU findings have been shown to predict future events, studies to date have shown poor correlation when compared to coronary angiography (CA). The objective of our study was to compare CU with CA and to evaluate how carotid atherosclerosis correlates with angiographic disease.
175 young adults undergoing elective CA were prospectively enrolled for CU screening. Inclusion criteria were age (men ≤ 55; women ≤ 65), no previous coronary heart disease or statin therapy. Abnormal CA was defined as stenosis severity of ≥ 50%. Criteria for abnormal CU included: maximal IMT > 1.0 mm in the main body; focal plaque at the body, bulb, or proximal branches; or calcific deposit in main body, bulb, or proximal branches.
Mean age (50.77 ± 7.47). 54% of subjects were women. Mean lipid levels were within desirable range. 93% of subjects were classified as low risk per the National Cholesterol Education Program III guidelines. 55 subjects had severe coronary artery disease (CAD). Neither mean nor maximal IMT correlated with CAD. By contrast, carotid plaque was associated with an OR of 2.1 (CI: 1.1 – 4.0, p = 0.002). Calcific plaques were not a frequent finding in young adults but were highly specific (90%) for CAD (OR: 2.5, CI: 1.1 – 5.8, p = 0.031). The sensitivity for carotid atherosclerosis compared to CAD was 75%, with a negative predictive value of 83% and specificity of 50%.CONCLUSIONS: Young adults with coronary angiographic disease also have carotid atherosclerosis. IMT in the main body does not correlate with angiographic CAD. However, carotid plaques in the body, bulb, or proximal branches predict angiographic CAD.
CU may be a valuable tool for risk stratification of individuals at risk for CAD.
K.O. Akosah, None.