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Original Articles
NUMBER 3-4 YEAR 2011
Role of Carotid Intima-Media Thickness for Cardiovascular Risk Evaluation
1 Department of Family Medicine,
2 Department of Health Management, Victor Babes University of Medicine and Pharmacy, Timisoara

Correspondence to:
Prof. Elena Aurora Ardeleanu, MD, PhD, Department of Family Medicine,
Victor Babes University of Medicine and Pharmacy, 14 T. Vladimirescu Str., Timisoara,
Tel. +40-256-492919
Email: ardeleanu.elena@clicknet.ro
REZUMAT
Introducere: Riscul cardiovascular (RCV) este subestimat la un procent important din populatie atunci cand este evaluat apeland la metode conventionale de estimare cum este riscul SCORE. Ecografia carotidiana, prin masurarea grosimii intima-medie (GIM) carotidiana, este utila in identificarea aterosclerozei subclinice si incadrarea astfel in clasa de RCV inalt. Obiectivul studiului: A fost evaluarea contributiei screening-ului grosimii intima-medie carotidiana in redefinirea RCV la o populatie de studiu asimptomatica incadrata in risc CV intermediar sau scazut (risc SCORE 3-4% sau sub 3%). Material si metode: Ecografia carotidiana s-a efectuat la 142 subiecti cu risc CV SCORE mic sau intermediar. Depistarea la ecografia carotidiana a unei GIM crescute a permis reclasficarea pacientilor in clasa de RCV inalt. Rezultate: RCV la lotul de studiu a fost mic la 40 (28,2 %) din pacienti si intermediar la 102 (71,8 %). GIM medie a fost de 0,65±0,14 mm. Rezultatele ecografiei carotidiene au reclasificat RCV la 39 (27,4%) pacienti. Reclasificarea s-a produs la 34 (33,3 %) subiecti cu RCV intermediar si la 5 (12,5%) subiecti din grupul cu RCV mic (p<0,05). Reclasificarea s-a asociat cu istoricul de hipertensiune arteriala (p<0.001), tensiunea arteriala sistolica crescuta (p=0,001), varsta (p<0,05), colesterolemia (p<0,05) si fumatul (p<0,05). Concluzii: Ecografia carotidiana este deosebit de utila in medicina preventiva. GIM carotidiana imbunatateste evaluarea RCV, identificand subiectii cu risc crescut, nedepistati prin evaluarea SCORE si contribuie astfel la instituirea unor strategii preventive mai agresive.

ABSTRACT
Background: Conventional risk evaluation as SCORE underestimates the cardiovascular risk (CVR) in a significant proportion of population. Carotid artery ultrasonography, by measurement of carotid intima-media thickness (IMT) is useful in identifying subclinical atherosclerosis and placing an individual into high CVR class. The objective of the study was to establish the contribution of IMT screening to the improvement of CVR in a study population of asymptomatic adults at intermediate ore low CHD risk (SCORE risk 3-4% or under 3%). Material and methods: Carotid artery ultrasonography was effectuated in 142 subjects, with low or intermediate SCORE risk class. The detection of abnormal IMT reclassified the subjects to high CVR class. Results: The calculated CVR of the study population by SCORE charts was low risk in 40 (28.2%) patients and intermediate in 102 (71.8 %) individuals. Mean IMT was 0.65±0.14 mm. The results of the ultrasonography reclassified the risk class in 39 patients (27.4%). Reclassification occurred in 34 (33.3 %) patients of the intermediate CVR group and 5 (12.5%) patients of the low CVR group (p<0.05). Reclassification was connected to history of arterial hypertension (p<0.001), increased systolic blood pressure (p=0.001), age (p<0.05), cholesterol levels (p<0.05) and smoking (p<0.05). Conclusions: Carotid ultrasonography is an important investigation in preventive medicine. IMT improves risk classification, identifying high risk individuals, not detected by SCORE function and contributes to establish earlier and more aggressive CV preventive strategies.


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