Screening for subclinical atherosclerosis by noninvasive methods in asymptomatic patients with risk factors

Abstract

Atherosclerosis is a leading cause of cardiovascular death due to the increasing prevalence of the disease and the impact of risk factors such as diabetes, obesity or smoking. Sudden cardiac death is the primary consequence of coronary artery disease in 50% of men and 64% of women. Currently the only available strategy to reduce mortality in the at-risk population is primary prevention; the target population must receive screening for atherosclerosis. The value of screening for subclinical atherosclerosis is still relevant, it has become standard clinical practice with the emergence of new noninvasive techniques (radio frequency [RF] measurement of intima-media thickness [RFQIMT] and arterial stiffness [RFQAS], and flow-mediated vasodilatation [FMV]), which have been used by our team since 2007 and are based on detection marker integrators which reflect the deleterious effect of risk factors on arterial remodeling before the onset of clinical events. These techniques allow the study of values according to age and diagnosis of the pathological value, the thickness of the intima media (RFQIMT), the speed of the pulse wave (RFQAS), and the degree of endothelial dysfunction (FMV). This screening is justified in asymptomatic patients with cardiovascular risk factors (hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking). Studies conducted by RF coupled with two-dimensional echo since 2007 have led to a more detailed analysis of the state of the arterial wall. The various examinations allow an assessment of the degree of subclinical atherosclerosis and its impact on arterial remodeling and endothelial function. The use of noninvasive imaging in screening and early detection of subclinical atherosclerosis is reliable and reproducible and allows us to assess the susceptibility of our patients with risk factors and ensures better monitoring of atherosclerosis, thus reducing the occurrence of cardiovascular events in the long term.

Chronic Inflammatory Diseases and Endothelial Dysfunction

“…Such diseases may occur before the appearance of a clinical illness and therefore act as an early identification objective [1,2].…”

“…These inflammatory and autoimmune diseases should now be considered as new cardiovascular risk factors. These non-traditional risk factors are said to contribute to atherogenesis via several mechanisms: autoantibodies against phospholipids: Anti Phospholipid Aging and Disease • Volume 7, Number 3, June 2016 2 Syndrome (APS); against cells: ds-ADN endothelial dsDNA (anti-double-stranded DNA antibodies (antidsDNA) purified from patients with active systemic lupus erythematosus (SLE) or neutrophil polynuclear anti cytoplasmic antibodies (NP), systemic inflammation, acute lipid oxidation, thermal shock proteins (HSP); antibodies against HSPs, association of anti-oxldl/2 Gp1 OxLDL/beta2GPI-anti-oxLDL/beta2GPI complex and atherosclerosis in SLE patients, immune complex and accelerated atherosclerosis in patients with primary APS oxLDL/B2GP1 and anti-oxLDL/B2GP1 [1,3,4]. We currently use several new non-invasive techniques to study arterial walls' structural and functional alterations.These non-invasive techniques allow for an assessment of artery age via calculations of intima-media thickness (RF-QIMT), pulse wave rate (RF-QAS) and endothelial dysfunction degree by FMD.…”

Risk Prediction for Subclinical Atherosclerotic Lesion of Brachiocephalic Arteries in Obese Women

“…Кроме того, ожидается дальнейшее увеличение распространенности ССЗ, ожирения и СД 2 типа, поэтому первичная профилактика атеро-склероза остается единственной доступной страте-гией снижения смертности от ССЗ [16]. В нашем исследовании у бессимптомных женщин с абдоминальным ожирением атеросклероз маги-стральных артерий определялся в 32,6% случаев, несмотря на это кардиоваскулярный риск по шкалам SCORE и Framingham в этой группе был низкий, а по шкале PROCAM высокий риск был определен только в 24,1% случаев.…”

Subclinical Indication of Linkage Between Markers of Skeletal and Cardiovascular Properties

“…Infrastructural compromise is initiated via activation of the renin angiotensin system (RAS) by elevated SBP, resulting in increases in cellular adhesion (increased endothelial ‘stickiness’) and macrophage infiltration of the vessel wall (23). In turn, the inflammatory cascade is activated, thereby degrading the endothelial matrix and activating differentiation of vascular smooth muscle cells (VSMC) toward the osteogenic lineage, promoting vascular calcification (24).…”