Canyons Medical Center, 9355 South 1300 E., Sandy, UT 84094, USA.
Postgrad Med. 2010 Jan;122(1):10-8. doi: 10.3810/pgm.2010.01.2091.
Heart disease is the primary cause of death in the United States. Fortunately, intervention measures can reduce the risk of cardiovascular disease (CVD) after a patient has been accurately assessed. Atherosclerotic disease, one of the driving forces behind CVD, is not always detected by traditional risk assessment. Carotid intima-media thickness (CIMT), as measured by B-mode ultrasound, is a surrogate marker for atherosclerosis and can be used to detect an accelerated disease process and subclinical disease. Advantages of CIMT are that it is noninvasive, relatively inexpensive, and can be repeatedly performed with no adverse effects on the patient. Carotid intima-media thickness is associated with CVD and is an independent predictor of stroke and myocardial infarction. Therefore, CIMT is valuable for clarifying CVD risk, particularly for patients with intermediate risk by conventional risk assessment. Screening for subclinical disease even in low-risk patients may have benefit, especially for those with a family history of premature CVD or those with any of the National Cholesterol Education Program risk factors. The detection of subclinical atherosclerosis allows the physician to implement prevention efforts prior to a devastating CVD event and to investigate possible reasons for increased arterial thickening, such as an occult underlying insulin-resistant condition or residual lipid risk markers. Treatment with several types of drugs has been demonstrated to halt the progression or even reduce CIMT. Carotid intima-media thickness is currently limited by the lack of standardized protocols that may affect reproducibility from measure to measure. Efforts to draft a standardized protocol are underway by the Society of Atherosclerosis Imaging and Prevention that will address this issue. Carotid intima-media thickness provides a valuable tool for physicians to clarify the CVD risk of their patients. Practical implications of CIMT for everyday clinical practice are addressed.
心脏病是美国的主要死亡原因。幸运的是，在对患者进行准确评估后，干预措施可以降低心血管疾病（CVD）的风险。动脉粥样硬化疾病是 CVD 的主要驱动因素之一，传统的风险评估并不总是能检测到它。颈动脉内膜中层厚度（CIMT），通过 B 型超声测量，是动脉粥样硬化的替代标志物，可用于检测加速的疾病过程和亚临床疾病。CIMT 的优点是它是非侵入性的，相对便宜，可以重复进行，对患者没有不良影响。颈动脉内膜中层厚度与 CVD 相关，是中风和心肌梗死的独立预测因子。因此，CIMT 对于明确 CVD 风险很有价值，特别是对于传统风险评估中处于中等风险的患者。即使在低危患者中筛查亚临床疾病也可能有益，特别是对于有早发性 CVD 家族史或有任何国家胆固醇教育计划风险因素的患者。亚临床动脉粥样硬化的检测使医生能够在破坏性 CVD 事件发生之前实施预防措施，并调查动脉增厚的可能原因，例如隐匿性潜在胰岛素抵抗状态或残留的脂质风险标志物。已经证明几种类型的药物治疗可以阻止 CIMT 的进展甚至使其减少。CIMT 目前受到缺乏标准化协议的限制，这些协议可能会影响从一次测量到另一次测量的可重复性。动脉粥样硬化成像和预防协会正在努力制定标准化协议，以解决这个问题。颈动脉内膜中层厚度为医生提供了一种有价值的工具，用于明确患者的 CVD 风险。还讨论了 CIMT 对日常临床实践的实际意义。
