Advanced carotid atherosclerosis in middle-aged subjects: comparison with PROCAM and SCORE risk categories, the potential for reclassification and cost-efficiency of carotid ultrasound in the setting of primary care
OBJECTIVE About 50% of acute coronary syndromes occur in patients classified as being at low coronary risk. We aimed to assess the potential preventive benefit of carotid plaque imaging with ultrasound. METHODS We assessed the prevalence of “old” a...
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2019-07-01
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| Series: | Swiss Medical Weekly |
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| Online Access: | https://www.smw.ch/index.php/smw/article/view/2647 |
| _version_ | 1811194199520837632 |
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| author | Michel Romanens Isabella Sudano Ansgar Adams Walter Warmuth |
| author_facet | Michel Romanens Isabella Sudano Ansgar Adams Walter Warmuth |
| author_sort | Michel Romanens |
| collection | DOAJ |
| description |
OBJECTIVE
About 50% of acute coronary syndromes occur in patients classified as being at low coronary risk. We aimed to assess the potential preventive benefit of carotid plaque imaging with ultrasound.
METHODS
We assessed the prevalence of “old” arteries (vascular age ≥70 years; VA70) in 3248 healthy subjects aged 40–65 years from the Swiss region of Olten and the German region of Koblenz. We compared sensitivity, specificity and discriminatory performance of SCORE, PROCAM and AGLA coronary risk calculators to detect VA70 for various decision thresholds and performed reclassification and cost-efficiency analysis.
RESULTS
VA70 was found in one out of eight subjects. Sensitivity for VA70 was 6% at the 10% AGLA threshold in women and 30% in men in the Olten area, which was confirmed for the Koblenz area with PROCAM (sensitivity 8% in women, 56% in men). Results were similar for SCORE. The discriminatory performance ranged between 0.69 and 0.82. Reclassification from low risk to a higher risk category occurred in 17–35% of patients. Analysis showed that carotid imaging for CHF 100 per person was highly cost efficient.
CONCLUSIONS
In subjects aged 40–65 years, the prevalence of old arteries is one out of eight and the detection rate of AGLA and SCORE is lower in women (6% for PROCAM) than for men (30%) at the 10% threshold. Carotid imaging may be used to reclassify subjects from low to intermediate or high cardiovascular risk. Our method is highly cost efficient at a price of CHF 100 per examination.
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| first_indexed | 2024-04-12T00:21:58Z |
| format | Article |
| id | doaj.art-1bf58a5fd0d0428c836d063ee2053100 |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-12T00:21:58Z |
| publishDate | 2019-07-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-1bf58a5fd0d0428c836d063ee20531002022-12-22T03:55:41ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972019-07-01149293010.4414/smw.2019.20006Advanced carotid atherosclerosis in middle-aged subjects: comparison with PROCAM and SCORE risk categories, the potential for reclassification and cost-efficiency of carotid ultrasound in the setting of primary careMichel Romanens0Isabella Sudano1Ansgar Adams2Walter Warmuth3Vascular Risk Foundation, Olten, SwitzerlandUniversity Heart Centre, Cardiology, University Hospital Zurich, SwitzerlandBAD Gesundheitsvorsorge und Sicherheitstechnik GmbH, Bonn, GermanySenior Analyst, Team Beratung und Gesundheitsökonomie, Gesundheitsforen Leipzig, Germany OBJECTIVE About 50% of acute coronary syndromes occur in patients classified as being at low coronary risk. We aimed to assess the potential preventive benefit of carotid plaque imaging with ultrasound. METHODS We assessed the prevalence of “old” arteries (vascular age ≥70 years; VA70) in 3248 healthy subjects aged 40–65 years from the Swiss region of Olten and the German region of Koblenz. We compared sensitivity, specificity and discriminatory performance of SCORE, PROCAM and AGLA coronary risk calculators to detect VA70 for various decision thresholds and performed reclassification and cost-efficiency analysis. RESULTS VA70 was found in one out of eight subjects. Sensitivity for VA70 was 6% at the 10% AGLA threshold in women and 30% in men in the Olten area, which was confirmed for the Koblenz area with PROCAM (sensitivity 8% in women, 56% in men). Results were similar for SCORE. The discriminatory performance ranged between 0.69 and 0.82. Reclassification from low risk to a higher risk category occurred in 17–35% of patients. Analysis showed that carotid imaging for CHF 100 per person was highly cost efficient. CONCLUSIONS In subjects aged 40–65 years, the prevalence of old arteries is one out of eight and the detection rate of AGLA and SCORE is lower in women (6% for PROCAM) than for men (30%) at the 10% threshold. Carotid imaging may be used to reclassify subjects from low to intermediate or high cardiovascular risk. Our method is highly cost efficient at a price of CHF 100 per examination. https://www.smw.ch/index.php/smw/article/view/2647accuracy of risk calculatorsatherosclerosiscarotid plaquePrimary preventionvascular age |
| spellingShingle | Michel Romanens Isabella Sudano Ansgar Adams Walter Warmuth Advanced carotid atherosclerosis in middle-aged subjects: comparison with PROCAM and SCORE risk categories, the potential for reclassification and cost-efficiency of carotid ultrasound in the setting of primary care Swiss Medical Weekly accuracy of risk calculators atherosclerosis carotid plaque Primary prevention vascular age |
| title | Advanced carotid atherosclerosis in middle-aged subjects: comparison with PROCAM and SCORE risk categories, the potential for reclassification and cost-efficiency of carotid ultrasound in the setting of primary care |
| title_full | Advanced carotid atherosclerosis in middle-aged subjects: comparison with PROCAM and SCORE risk categories, the potential for reclassification and cost-efficiency of carotid ultrasound in the setting of primary care |
| title_fullStr | Advanced carotid atherosclerosis in middle-aged subjects: comparison with PROCAM and SCORE risk categories, the potential for reclassification and cost-efficiency of carotid ultrasound in the setting of primary care |
| title_full_unstemmed | Advanced carotid atherosclerosis in middle-aged subjects: comparison with PROCAM and SCORE risk categories, the potential for reclassification and cost-efficiency of carotid ultrasound in the setting of primary care |
| title_short | Advanced carotid atherosclerosis in middle-aged subjects: comparison with PROCAM and SCORE risk categories, the potential for reclassification and cost-efficiency of carotid ultrasound in the setting of primary care |
| title_sort | advanced carotid atherosclerosis in middle aged subjects comparison with procam and score risk categories the potential for reclassification and cost efficiency of carotid ultrasound in the setting of primary care |
| topic | accuracy of risk calculators atherosclerosis carotid plaque Primary prevention vascular age |
| url | https://www.smw.ch/index.php/smw/article/view/2647 |
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