title: Early atherosclerosis detection in asymptomatic patients: a comparison of carotid ultrasound, coronary artery calcium score, and coronary computed tomography angiography.
abstract: BACKGROUND
  Detailed multimodality assessment of subclinical atherosclerosis in asymptomatic subjects referred for risk stratification has not been performed. We analyzed the detection of early atherosclerosis using 3 imaging modalities: coronary artery calcium (CAC) scoring, carotid ultrasound (US), and coronary computed tomography angiography (CCTA).
  
  
  METHODS
  Asymptomatic subjects free of known vascular disease scheduled to undergo a carotid US for risk stratification were invited to undergo CCTA/CAC. Subjects taking lipid-lowering medication were excluded. All images were assessed by experienced core laboratory personnel. Carotid intima media thickness ≥ 75th percentile for age and sex, CAC > 0, and detection of either carotid or coronary artery plaque were indicators of atherosclerosis.
  
  
  RESULTS
  Fifty patients were included with a median age of 53 years. Atherosclerosis was observed in 28%, 78%, and 90% of subjects using CAC, CCTA, and carotid US, respectively. All subjects showed atherosclerosis on at least 1 modality. In 36 patients with a CAC score = 0, 69% and 86% had atherosclerosis on CCTA and carotid US, respectively.
  
  
  CONCLUSIONS
  In this detailed analysis, all subjects identified to warrant further risk stratification had subclinical atherosclerosis on at least 1 imaging modality. Concordance between modalities was highly variable, dependent on the specific definition of atherosclerosis used. Carotid US and CCTA detection of plaque were significantly more sensitive than CAC > 0 in this middle-aged population. Considering the prevalence of subclinical disease on carotid US and CCTA, the threshold at which to treat warrants further research.
authors.affiliation: Division of Endocrinology and Metabolism, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schroeder
authors.forename: Gordon
authors.initials: G
authors.lastname: Francis
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.forename: Brett
authors.initials: B
authors.lastname: Heilbron
authors.forename: G B
authors.initials: GB
authors.lastname: John Mancini
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D001955:British Columbia; D002114:Calcinosis / Q000145:classification / Q000175:diagnosis*; D016893:Carotid Stenosis / Q000145:classification / Q000175:diagnosis*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000145:classification / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography