title: Is carotid artery evaluation necessary for primary prevention in asymptomatic high-risk patients without atherosclerotic cardiovascular disease?
abstract: OBJECTIVE
  Routine measurement of the carotid intima-media thickness is not recommended in recent clinical practice guidelines for risk assessment of the first atherosclerotic cardiovascular disease (ASCVD) event (the definition of which includes acute coronary syndromes, a history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin). The aim of the present study was to elucidate the role of carotid artery evaluation for primary prevention of ASCVD in asymptomatic high-risk patients visiting a teaching hospital.
  
  
  METHODS
  Eight hundred seventy-three patients (487 male [55.8%], mean age 59.4±11.5 years) who were statin-naive and without ASCVD, which was proven by coronary angiography or coronary CT angiography, were enrolled in this study. The patients underwent carotid scanning in the Medical Department of St Mary's Hospital from September 2003 to March 2009. ASCVD outcomes were evaluated for median follow-up of 1,402 days.
  
  
  RESULTS
  A total of 119 participants experienced ASCVD events. In multivariate Cox regression analysis, age (hazard ratio [HR] =1.026, 95% confidence interval [CI] =1.002-1.050, P=0.033), history of smoking (HR =1.751, 95% CI =1.089-2.815, P=0.021), statin therapy (HR =0.388, 95% CI =0.205-0.734, P=0.004), and carotid plaques (HR =1.556, 95% CI =1.009-2.400, P=0.045) were associated with ASCVD events. In middle-aged group (45≤ age <65, n=473), history of smoking (HR =1.995, 95% CI =1.142-3.485, P=0.015), statin therapy (HR =0.320, 95% CI =0.131-0.780, P=0.012), and carotid plaques (HR =1.993, 95% CI =1.116-3.560, P=0.020) were associated with ASCVD events.
  
  
  CONCLUSIONS
  The presence of carotid plaques, history of smoking, and statin therapy might be important factors for primary prevention of ASCVD in asymptomatic high-risk patients, especially in middle-aged patients. Therefore, the results suggest that carotid artery parameters may have an additional predictive value for primary prevention of ASCVD in the middle-aged high-risk patients.
authors.affiliation: Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea.
authors.forename: GeeHee
authors.initials: G
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Youn
authors.affiliation: Division of Cardiology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Yun-Seok
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Hae Ok
authors.initials: HO
authors.lastname: Jung
authors.affiliation: Division of Cardiology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Wook Sung
authors.initials: WS
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea.
authors.forename: Chul-Min
authors.initials: CM
authors.lastname: Kim
mesh_terms: D000367:Age Factors; D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D002339:Carotid Arteries; D059168:Carotid Intima-Media Thickness; D015897:Comorbidity; D017023:Coronary Angiography; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: asymptomatic high-risk patients; atherosclerotic cardiovascular event; carotid plaque; cholesterol-lowering drug therapy; primary prevention