An exploration of potential approaches to improve the diagnosis of subclinical atherosclerosis in patients with high cardiovascular risk

Abstract

Purpose. The search for optimal approaches to the diagnosis of subclinical atherosclerosis using a wide range of traditional and psychosocial risk factors (RFs), as well as clinical and instrumental diagnostic methods in patients (pts) with high or very high cardiovascular (CV) risk. Methods. This cross-sectional study enrolled52 pts, aged 40 to 65 years with high or very high CV risk (5-9 and ≥10% by the Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT)angiography and calcium scoring. Traditional RFs (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound, arterial stiffness were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality. Results. All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n=21) had any non-obstructive lesions or calcium score >0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. It was found that patients with subclinical atherosclerosis significantly more often have a very high (≥10%) CV risk (42.9% vs.16.3%, p<0.05), a long (≥5 years) history of arterial hypertension (47.6% vs. 12.9% , p<0.01) and longer duration of antihypertensive therapy (61.9% vs. 29.0%, p<0.05), higher heart rate in rest (87. ± 14 vs. 77 ± 10 beats/min, p<0.01), increased arterial stiffness according to aortic pulse wave velocity (85.7% vs. 61.3%, p<0.05) and high level of hs-CRP (100% vs. 90.3%, p<0.05). Conclusion. Using in routine clinical practice of additional anamnestic (hypertension lasting ≥ 5 years and the intake of any antihypertensive drugs) and clinical-instrumental parameters (high heart rate in rest, hs CRP and arterial stiffness in pts with high and very high CV risk increases effectiveness of early detection of subclinical atherosclerosis.