title: Asymptomatic carotid lesions add to cardiovascular risk prediction.
abstract: OBJECTIVE
  To show that subclinical atherosclerosis (subclinical-ATS) of carotid arteries [intima-media thickness (IMT) or asymptomatic carotid plaque (ACP)], may provide additional information for risk stratification, in asymptomatic patients, aged greater than 45 years, with a cluster of risk factors (RFs).
  
  
  RESULTS
  We studied 558 asymptomatic patients (235 males). RFs for atherosclerosis were assessed and the 10-year-risk was calculated according to the Italian risk score. Doppler ultrasound of carotid arteries identified the presence of IMT greater than 0.9 mm in 183 patients and ACP in 147 patients. One hundred and fifty-three patients developed cerebrovascular or cardiovascular (CV) events in the follow-up: 67 developed acute myocardial infarction, 39 developed angina, 25 had a stroke or transient ischemic attack, six died for CV events, and 16 underwent percutaneous or surgical revascularization. The incidence reflected the different risk profiles (4, 14, and 20%, respectively). However, in patients with baseline subclinical-ATS the incidence of events increased to 35, 46, and 63%, respectively. In the multivariate analysis the incidence of events was significantly influenced by the presence of asymptomatic carotid lesions in each risk category.
  
  
  CONCLUSIONS
  In our experience, the incidence of CV events is enhanced in patients with subclinical-ATS. Increased IMT and ACP predict CV events and improve the risk stratification of asymptomatic patients aged greater than 45 years and with a cluster of RFs, in a long-term follow-up.
authors.affiliation: School of Cardiovascular Disease, Center for Diagnosis of Subclinical and Multifocal Atherosclerosis and Secondary Prevention, Division of Cardiology, Department of Internal Medicine, Cardiovascular and Nephro-Urological Diseases of the University Hospital Paolo Giaccone, Palermo, Italy. novosav@unipa.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Novo
authors.forename: Claudia L
authors.initials: CL
authors.lastname: Visconti
authors.forename: Gisella R
authors.initials: GR
authors.lastname: Amoroso
authors.forename: Egle
authors.initials: E
authors.lastname: Corrado
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fazio
authors.forename: Ida
authors.initials: I
authors.lastname: Muratori
authors.forename: Rosalba
authors.initials: R
authors.lastname: Tantillo
authors.forename: Monica
authors.initials: M
authors.lastname: Lunetta
authors.forename: Luciana
authors.initials: L
authors.lastname: D'Angelo
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Novo
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D006801:Humans; D007558:Italy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler