Subclinical arteriosclerosis screening. The PAP/PEA study. Prevalenza dell'Arteriosclerosi Precoce (Prevalence of Early Arteriosclerosis).
Noninvasive screening of subclinical atherosclerosis is possible with ultrasonic biopsy (UB) performed with high resolution ultrasound scanning. Five UB classes have been identified, each class corresponding to a different incidence of cardiovascular events (CVE) in 4 years and silent coronary ischemia (SCI). In a study including 2230 asymptomatic subjects 3 risk groups were defined. In the low risk group (class I and II; 82.01% of the population sample) the incidence of CVE and SCI was zero. These subjects may be seen again after 3 years. In the moderate risk group (class II and IV; 13.3%) monitoring and early intervention may be needed. In the high risk group (class V; 4.6%) prophylaxis or treatment may be necessary. The screening is effective, simple and may be organised at very low cost--i.e. 30.000 asymptomatic subjects may be scanned at the cost of 100.000 ECU. Each scan, including carotid and femoral bifurcations, may be performed in 15 minutes. In our communities this cost is equivalent to the average cost of a single major stroke or major coronary ischemic event in a working adult aging between 45 and 60. Organization problems and the fragmentation of competences has prevented the evolution of atherosclerosis screening. The problem can be solved organising a network including epidemiologists, angiologists and cardiovascular surgical centres where all phases of atherosclerosis may be studied and detected, progression prevented and complications treated with a global vision of the disease.
Belcaro
G
G
Cardiovascular Institute, Chieti University, Italy.
Geroulakos
G
G
Laurora
G
G
Cesarone
M R
MR
de Sanctis
M T
MT
Incandela
L
L
Barsotti
A
A
Nicolaides
A N
AN
D000293:Adolescent; D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002648:Child; D004562:Electrocardiography; D005080:Exercise Test; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D014463:Ultrasonography