A recent study indicates that using imaging techniques for early detection and ongoing monitoring can enhance our ability to predict and prevent early death.
Researchers from Mount Sinai Fuster Heart Hospital have found that the development of atherosclerosis in individuals who show no symptoms is independently linked to a heightened risk of death from any cause. This research was published on September 30 in the Journal of the American College of Cardiology.
This study is groundbreaking as it demonstrates that advanced imaging can identify atherosclerotic disease in major blood vessels long before any symptoms manifest. This method has the potential to be implemented globally to avert cardiovascular diseases and reduce mortality risk. The results highlight the crucial role of early detection in managing atherosclerosis.
“The long asymptomatic phase of the disease presents a window of opportunity that has not been exploited in the younger population,” states lead author Valentin Fuster, MD, PhD, who serves as President of Mount Sinai Fuster Heart Hospital and General Director of the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC).
Atherosclerosis involves the build-up of fats, such as cholesterol, along with other substances, creating plaques on the walls of arteries. This condition leads to the hardening and narrowing of blood vessels, which increases the risk of severe cardiac events. Subclinical atherosclerosis is prevalent, where plaques form in arteries without presenting any signs of disease, potentially affecting individuals of any age. This condition can escalate into serious health issues like stroke, heart attack, and chronic limb-threatening ischemia.
Despite progress in cardiovascular studies, it has remained uncertain whether the risk of death from all causes in symptom-free individuals can be predicted by assessing the extent and progression of atherosclerosis, particularly in the carotid arteries that supply blood to the brain.
The aim of the recent study, known as the BioImage project, which is a partnership between Mount Sinai and CNIC, was to ascertain the independent predictive value of the burden and advancement of subclinical atherosclerosis beyond conventional cardiovascular risk factors.
The study encompassed 5,716 asymptomatic adults in the U.S., averaging 69 years old (56.7% women), who were examined between 2008 and 2009. Participants underwent two different imaging methods. Vascular ultrasound was used to assess atherosclerotic plaques in the carotid arteries, allowing detailed visualization, while computed tomography was used to analyze calcification in the coronary arteries.
A smaller group of 732 participants had a follow-up vascular ultrasound conducted more than eight years after the initial assessment. All individuals were monitored to track the rate of death from any cause, which was the primary outcome of the study.
Throughout a follow-up period of 12.4 years, 901 (16%) participants passed away. Initial measurements of carotid plaque burden and coronary artery calcification were both linked to overall mortality. Additionally, the progression of carotid atherosclerosis offered further prognostic insight and was also independently related to all-cause mortality.
“Vascular ultrasound is a non-invasive and cost-effective examination, and the insightful prognostic data it provides can assist in improving risk stratification and tailoring lifestyle modifications for managing cardiovascular risk factors,” remarks Borja Ibáñez, PhD, Scientific Director at the CNIC.
The findings of the study affirm that early detection of subclinical atherosclerosis and monitoring its development can enhance the prediction and prevention of death from various causes, serving as a significant asset for clinical practice.
