title: Effects of an office-based carotid ultrasound screening intervention.
abstract: BACKGROUND
  Carotid ultrasound screening (CUS) has been recommended for cardiovascular disease risk prediction, but its effectiveness in clinical practice is unknown. The purpose of this study was to prospectively determine the effects of office-based CUS on physician decision making and patient health-related behaviors.
  
  
  METHODS
  Physicians from five nonacademic, community practices recruited patients aged ≥40 years with ≥1 cardiovascular disease risk factor. Abnormal results on CUS (AbnlCUS) were defined as carotid intima-media thickness >75th percentile or carotid plaque presence. Subjects completed questionnaires before and immediately after CUS and then 30 days later to determine self-reported behavioral changes. Odds ratios (ORs) for changes in physician management and patient health-related behaviors were determined from multivariate hierarchical logistic regression models.
  
  
  RESULTS
  There were 355 subjects (mean age, 53.6 ± 7.9 years; mean number of risk factors, 2.3 ± 0.9; 58% women); 266 (74.9%) had AbnlCUS. The presence of AbnlCUS altered physicians' prescription of aspirin (P < .001) and cholesterol medications (P < .001). Immediately after CUS, subjects reported increased ability to change health-related behaviors (P = .002), regardless of their test results. Subjects with AbnlCUS reported increased cardiovascular disease risk perception (OR, 4.14; P < .001) and intentions to exercise (OR, 2.28; P = .008), make dietary changes (OR, 2.95; P < .001), and quit smoking (OR, 4.98; P = .022). After 30 days, 34% increased exercise frequency and 37% reported weight loss, but these changes were not predicted by the CUS results. AbnlCUS modestly predicted reduced dietary sodium (OR, 1.45; P = .002) and increased fiber (OR, 1.55; P = .022) intake.
  
  
  CONCLUSIONS
  Finding abnormal results on CUS had major effects on physician but not patient behaviors.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA..
authors.forename: Heather M
authors.initials: HM
authors.lastname: Johnson
authors.forename: Terry L
authors.initials: TL
authors.lastname: Turke
authors.forename: Mark
authors.initials: M
authors.lastname: Grossklaus
authors.forename: Tara
authors.initials: T
authors.lastname: Dall
authors.forename: Sanford
authors.initials: S
authors.lastname: Carimi
authors.forename: Laura M
authors.initials: LM
authors.lastname: Koenig
authors.forename: Susan E
authors.initials: SE
authors.lastname: Aeschlimann
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Korcarz
authors.forename: James H
authors.initials: JH
authors.lastname: Stein
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009819:Office Visits; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D018608:Ultrasonography, Doppler / Q000379:methods*; D014922:Wisconsin / Q000453:epidemiology