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ICEBERG-2: INTIMAL CAROTID EVALUATION BEFORE ECHOCARDIOGRAPHY, RELATIONSHIP TO GLOBAL RISK SCORES

Author Block M Matangi, D Armstrong, U Jurt, D Brouillard, A Johri

Kingston, Ontario

Abstract:
BACKGROUND: In the first year of screening ICEBERG assessed the prevalence of carotid disease in Statin naïve patients without known vascular disease presenting for a routine ECHO. In ICEBERG-2, we have now correlated the carotid findings with the patient’s global Framingham risk score (FRS).
METHODS: Males ≥40 years and females ≥50 years presenting for a routine ECHO were asked to participate. Patients were Statin naive and had no known vascular disease. All gave signed informed consent. Four to six carotid images were taken at the beginning of the ECHO study. Common carotid artery intimal medial thickness (CCA IMT) was measured offline using an automatic edge detection program. Carotid plaque was assessed as either absent or present using the ARIC study criteria. In the absence of carotid plaque, a markedly abnormal CCA IMT was taken as ≥1.20mm which is the highest O’Leary quintile.
RESULTS: 735 consecutive patients referred for an ECHO were screened. 482 were excluded, 213 for known vascular disease (165 Rx with Statin), another 210 were taking a Statin and 17 were under the age criteria. Forty-two (5.7%) either refused carotid screening or refused to have their lipid profile checked or both. One hundred and four patients were high FRS, 97 had an LDL Cholesterol above CCS guideline for initiating treatment. Eighty patients were intermediate FRS, 23 had an LDL Cholesterol above the CCS guideline for treatment. The prevalence of an abnormal carotid according to low, intermediate and high FRS is seen in the figure below.
CONCLUSION:
1. 120 of the 253 patients screened should have been prescribed a Statin based on their calculated FRS and their LDL Cholesterol. One presumes the FRS was never calculated?
2. The overall prevalence of carotid disease in this population without known vascular disease is high, (62.1%).
3. The prevalence of an abnormal carotid in low FRS is 36.2%. Such patients with an LDL >2.00mmol/l should be treated with a Statin according to CCS lipid guidelines.
4. The prevalence of an abnormal carotid in intermediate FRS is high at 62.5%. Only 11 of those with an abnormal carotid (N=48) were captured by their intermediate risk category and LDL cholesterol >3.5mmol/l.
5. 21% of high FRS patients do not have evidence of carotid disease as defined.
6. Carotid screening could be justified in all males ≥40yrs and females ≥50yrs referred for an ECHO who are Statin naive and do not have known vascular disease.