Ultrasound Detection of Increased Carotid Intima-Media Thickness and Carotid Plaque in an Office Practice Setting: Does It Affect Physician Behavior or Patient Motivation?

Korcarz, Claudia E.; DeCara, Jeanne M.; Hirsch, Alan T.; Mohler, Emile R.; Pogue, Brian W.; Postley, John; Tzou, Wendy S.; Stein, James H.

doi:10.1016/j.echo.2008.05.001

Cited by 53 publications

(60 citation statements)

References 34 publications

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“…94 A subsequent, more recent study, on the other hand, did show that CAC screening motivated the initiation of CHD preventative measures. 95 A similar effect of office-based CIMT screening on physician behavior and patient motivation was demonstrated in a recent study 96 showing that physicians were more likely to prescribe evidence-based, CHD riskreducing interventions such as aspirin and lipid-lowering therapies if increased CIMT or carotid plaque was documented. In the same study, the act of screening itself increased patients' stated motivation to make dietary changes and increase exercise.…”

Section: Does Atherosclerosis Imaging Change Care?mentioning

confidence: 80%

Atherosclerosis Imaging

Kaul

Douglas

2009

Circ: Cardiovascular Imaging

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Despite the epidemiological insights from the Framingham Study 1 in the early 1950s and the resulting significant advances in the diagnosis and management of coronary heart disease (CHD), it remains the leading cause of death in the United States. In part, this is because sudden cardiac death is the first presentation of CHD in 50% of men and 64% of women 2,3 and, therefore, the only available strategy for reducing mortality in these patients is primary prevention. This is the target population for atherosclerosis imaging, which has been proposed as a strategy for the earlier and more accurate identification of individuals at risk for CHD so that lifesaving preventive strategies can be more optimally targeted in those at risk. Limitations of Current Primary Risk Assessment StrategiesCurrent guidelines for primary prevention recommend initial assessment and risk stratification based on traditional risk factors (eg, the Framingham Risk Score [FRS] in the United States and the Systemic Coronary Risk Evaluation in Europe), followed by goal-directed therapy as necessary to modify those risk factors. 4 However, these traditional prevention strategies can be inadequate, as cardiovascular events do occur in patients without known risk or in low and intermediate risk groups in whom an aggressive treatment strategy would not be indicated. This is highlighted by a study of 222 young adults (men Յ55 years and women Յ65 years) without known prior CHD, hospitalized for acute myocardial infarction, of whom 70% were in a low-risk category with a 10-year risk of CHDϽ10% based on their FRS. 5 Furthermore, when the 10-year risk of these patients was stratified by number of risk factors and low-density lipoprotein cholesterol level, three quarters did not meet National Cholesterol Education Program III criteria 6 to be identified as at sufficient risk to qualify for cholesterol lowering therapy. Part of the reason why FRS fails to detect risk may be its development in an almost entirely white population such that the risk prediction algorithm may not fit other populations as well. 7 Furthermore, the model ignores several major risk factors including diabetes, family history sedentary lifestyle and obesity.

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Section: Does Atherosclerosis Imaging Change Care?mentioning

confidence: 80%

Atherosclerosis Imaging

Kaul

Douglas

2009

Circ: Cardiovascular Imaging

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“…After a two-step screening process, 12 articles fulfilled the inclusion criteria. 11,[14][15][16][17][18]32,[35][36][37][38][39] Using the abstract and title on the first screen, 13 disagreements concerning eligibility for a full-text review occurred between the two reviewers (kappa=0.81). For the second screen, which was based on the full-text review of 41 studies, there was one disagreement (kappa=0.94).…”

Section: Resultsmentioning

confidence: 99%

“…In the RCTs, screening for atherosclerosis did not improve CVRF, but an increased smoking cessation rate (18% vs. 6%, p=0.03) was found in a single RCT. 11 Non-randomized studies showed potential positive effects of atherosclerosis screening on "intermediate" outcomes, such as increased motivation to change lifestyle 36,37 and an increased perception of CV risk. 14,18,37,39 However, such data were based on self-report and limited by the lack of a randomized control group.…”

Section: Discussionmentioning

confidence: 99%

Atherosclerosis Screening by Noninvasive Imaging for Cardiovascular Prevention: A Systematic Review

et al. 2011

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“…These include abbreviated scanning protocols which make the test less time-consuming, 64 semi-automated border detection programs which improve the reproducibility and speed of measuring CIMT, 64,65 as well as the use of non-sonographer clinicians who can perform this test in an office setting rather than a traditional radiology or vascular laboratory. 66,67 Abbreviated scanning protocols include circumferential carotid plaque screening of all visualized segments of both carotid arteries as an initial step. 64 If carotid plaque is detected, CIMT imaging can be considered optional, as the detection of carotid plaques may provide sufficient justification for intensifying risk reducing therapy.…”

Section: Barriers To Clinical Usementioning

confidence: 99%