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ICEBERG, does carotid ultrasound provide additional risk information in some low Framingham risk score patients?

EuroPRevent 2014  
Doctor Murray Matangi (EUD ID : 32405)
Kingston Heart Clinic
Cardiology Dept.
460 Princess Street
K7L 1C2 - Kingston Canada
Phone : +1 6135443242 - Fax : +1 6135464487
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
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Title : ICEBERG, does carotid ultrasound provide additional risk information in some low Framingham risk score patients?
Topic : 01.08 - Atherosclerosis/CAD (Prevention & Epidemiology)
Acronym : Initial Carotid Evaluation Before Echocardiography Reveals Global risk.
Category : Not Member of EACPR
Option : No Options
M. Matangi1, DW. Armstrong1, D. Brouillard1, U. Jurt1, AM. Johri2 - (1) Kingston Heart Clinic, Kingston, Canada (2) Queen's University, Kingston, Canada
Purpose. Canadian lipid guidelines allow imaging for atherosclerosis in those patients who are intermediate risk (10-19% 10 year cardiovascular risk) using the global Framingham risk score (FRS). Low FRS patients have a 10 year cardiovascular risk of <10%. The purpose of this analysis is to report the prevalence of carotid atherosclerosis in patients with low FRS <5 compared to 5 to <10.
Methods. Consecutive low FRS patients undergoing a routine ECHO for murmur, arrhythmia, hypertension or dyspnea also underwent carotid screening. Patients were males ≥40 years or females ≥50 years. All patients were statin naive. Patients with a prior history of a vascular event or diabetes were excluded. Patients were divided into those with a FRS of <5 and those with a FRS of 5 to <10. Our carotid screening involves 2 or 3 images on each side to include the CCA, carotid bulb and ICA. Carotid plaque was defined using the ARIC criteria. CCA IMT was measured offline in the far wall of the CCA. All patients gave signed informed consent.
Results. There were 102 consecutive patients with low FRS. Thirty-eight had a FRS <5 (84% female, mean age 53.1±5.6yrs, Maximal CCA IMT 0.78±0.14mm) of which 3 had carotid plaque, prevalence 7.9%. There were 64 patients with FRS of 5 to <10 (73% female, mean age 56.8±7.1yrs, Maximal CCA IMT 0.93±0.24mm) of which 30 had carotid plaque, prevalence 46.9%. The 30 patients with FRS of 5 to <10 are high-risk equivalents, 29 of the 30 had an LDL-cholesterol >2.00mmol/l (mean 3.19±0.73) and would be eligible for Statin therapy.
Conclusions. Patients with low FRS of 5 to <10 should undergo carotid ultrasound to assess the presence of carotid plaque. Such patients are at increased risk for cardiovascular events and may benefit from preventative strategies such as Aspirin and Statin therapy.
% of plaque in low Framingham risk.