Sebastian Sneha Annie, Co Edzel Lorraine, Tidd-Johnson Atiyah, Chowdhury Selia, Jain Esha, Davidson Michael, Johal Gurpreet
Department of Internal Medicine, Azeezia Medical College, Kollam, Kerala, India.
Department of Internal Medicine, University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines.
Curr Probl Cardiol. 2024 Jan;49(1 Pt C):102147. doi: 10.1016/j.cpcardiol.2023.102147. Epub 2023 Oct 19.
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide, and its prevention is more cost-effective than the treatment of its complications. Although cardiovascular (CV) risk assessment based on conventional risk factors is the general recommendation, a significant percentage of the population, irrespective of these risk factors, present with subclinical atherosclerosis during carotid Doppler ultrasound (US) imaging. Subclinical atherosclerotic lesions at the carotid bifurcations may be related to the incidence of future CV events and occult atherosclerotic coronary disease. Such patients might benefit from preventive measures if the carotid Doppler US is allowed as a screening tool to detect the extent of carotid stenosis. We aimed to conduct a comprehensive and systematic evaluation of the impact of carotid US screening on CV risk stratification.
We searched PubMed, Scopus, and ScienceDirect from inception until July 2023. We included literature that examined the impact of carotid US screening on cardiovascular risk factor (CVRF) prevention, CV events, and mortality in adults of all age groups free of symptomatic carotid artery disease.
We identified 2 randomized controlled trials (RCTs) and 9 observational studies, including 21,046 participants. The mean age of the participants was 49, and 53% were female. Two RCTs, with 7,064 participants, examined the impact of pictorial knowledge about subclinical carotid atherosclerosis using carotid US versus traditional CVD risk evaluation without any US evidence in primary cardiovascular prevention. Both studies reported remarkable improvement in medication adherence at 1 to 3-year follow-up after carotid US screening with a decrease in Framingham risk score (FRS). Nine observational studies with 13, 982 participants analyzed the evidence of atherosclerosis on carotid US screening and demonstrated that it is a beneficial tool in the early identification of subclinical atherosclerosis and effective therapeutic intervention.
This systematic review found that pictorial presentation of silent atherosclerosis using carotid US screening has a contributory role in CV risk stratification and prevention of CVD.
心血管疾病（CVD）是全球发病和死亡的主要原因，其预防比治疗并发症更具成本效益。尽管基于传统风险因素的心血管（CV）风险评估是普遍建议，但相当一部分人群，无论这些风险因素如何，在颈动脉多普勒超声（US）成像期间都存在亚临床动脉粥样硬化。颈动脉分叉处的亚临床动脉粥样硬化病变可能与未来CV事件的发生率和隐匿性动脉粥样硬化性冠状动脉疾病有关。如果允许将颈动脉多普勒超声作为检测颈动脉狭窄程度的筛查工具，这些患者可能会从预防措施中受益。我们旨在对颈动脉超声筛查对CV风险分层的影响进行全面系统的评估。
我们检索了从创刊至2023年7月的PubMed、Scopus和ScienceDirect。我们纳入了研究颈动脉超声筛查对所有年龄组无症状颈动脉疾病成年人的心血管危险因素（CVRF）预防、CV事件和死亡率影响的文献。
我们确定了2项随机对照试验（RCT）和9项观察性研究，包括21,046名参与者。参与者的平均年龄为49岁，53%为女性。两项RCT共7,064名参与者，研究了在初级心血管预防中使用颈动脉超声与无任何超声证据的传统CVD风险评估相比，关于亚临床颈动脉粥样硬化的图像知识的影响。两项研究均报告，在颈动脉超声筛查后的1至3年随访中，药物依从性有显著改善，弗雷明汉风险评分（FRS）降低。9项观察性研究共13,982名参与者分析了颈动脉超声筛查中动脉粥样硬化的证据，并表明它是早期识别亚临床动脉粥样硬化和有效治疗干预的有益工具。
本系统评价发现，使用颈动脉超声筛查对无症状动脉粥样硬化进行图像呈现，在CV风险分层和CVD预防中具有促进作用。
