title: Should preclinical vascular abnormalities be measured in asymptomatic adults to improve cardiovascular risk stratification?
abstract: OBJECTIVE
  Guideline groups have issued contradictory decisions as to the value of noninvasive tests in asymptomatic adults at intermediate cardiovascular risk. Reclassification has only recently been accepted as a critical criterion to determine the utility of a diagnostic test. The present review examines potential limitations in reclassification and evaluates the utility of carotid ultrasound, pulse wave velocity and ankle brachial index from a clinical perspective.
  
  
  RESULTS
  Reclassification is less useful than generally believed, because therapy is already indicated in the majority of patients at intermediate risk and it is far from clear that treatment should be withheld in those who are downgraded in risk. Moreover, the additional benefit from more intensive therapy is much less than often thought. Reproducibility, standardization and reference values of noninvasive tests are obligatory before introduction in clinical care.
  
  
  CONCLUSIONS
  Routine screening of all those at intermediate risk does not appear to be justified. Screening should be performed on those individuals in whom the noninvasive test changes clinical care, which is most apparent for individuals at intermediate risk with LDL level less than 2.5 mmol/l, in whom positive noninvasive tests will result in the start of statin treatment. The primary value of these tests should not be to determine risk but to identify preclinical anatomic disease.
authors: Division of Vascular Medicine, Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. j.degraaf@aig.umcn.nl
authors: Jacqueline
authors: J
authors: de Graaf
authors: Suzanne
authors: S
authors: Holewijn
authors: Anton F
authors: AF
authors: Stalenhoef
authors: Allan D
authors: AD
authors: Sniderman
mesh_terms: D055109:Ankle Brachial Index / Q000145:classification*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D059168:Carotid Intima-Media Thickness / Q000145:classification*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D017410:Practice Guidelines as Topic; D011674:Pulse; D012016:Reference Values; D012307:Risk Factors