Skip to main content

Advertisement

SpringerLink
Log in

The utilization of carotid artery imaging beyond metabolic scores and high-sensitivity CRP in screening intermediate-to-high Framingham risk of asymptomatic Taiwanese population

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

To compare the diagnostic accuracy of various cardiovascular screening tools in asymptomatic subjects with intermediate-to-high risk Framingham risk score (FRS). In addition, we also investigated whether carotid artery study could further add incremental value beyond metabolic abnormality and inflammatory marker in this issue. 1,200 asymptomatic subjects who underwent health evaluation were recruited in our study. FRS was calculated in all participants based on clinical variables, body surface electrocardiography, medical histories, and life styles. Metabolic scores, serum high-sensitivity C reactive protein (hs-CRP) level and carotid artery study in assessing intima-media-thickness (CIMT) and plaque were all obtained and compared to FRS. Comparison of diagnostic accuracy was then conducted among these different tools aiming at a more efficient screen in identifying intermediate-to-high FRS. Of all, 1,101 participants (mean age 50.6 ± 10.4, 38.6 % women) were finally entered in our study after exclusion of known cardiovascular diseases. By utilizing common carotid IMT (CCIMT) equal or larger than 1 mm, best specificity (98.27, 95 % CI 97.24–98.99) was achieved in identifying intermediate-to-high FRS subject. The most optimal cut-off in identifying intermediate-to-high FRS for metabolic scores, hs-CRP and CCIMT was 2, 0.101 mg/dL and 0.65 mm, respectively. Both receiver operating characteristic curve and likelihood ratio tests showed that information provided by carotid artery study further showed significant incremental value when superimposed on metabolic scores and hs-CRP (all p < 0.05) in screening intermediate-to-high FRS subjects. Though diagnostic accuracy may differ to some degree by using different cut-off values, a low metabolic score seemed to have the best sensitivity with abnormal CCIMT yielded highest specificity in screening a subject with future cardiovascular risks. Carotid artery study added significant clinical incremental value in discriminating projected risk beyond metabolic scores and hs-CRP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K et al (2009) Heart disease and stroke statistics 2009 update: a report from the American Heart Association statistics committee and stroke statistics subcommittee. Circulation 119:480–486

    Article  PubMed  Google Scholar 

  2. Cupples LA, D’Agostino RB (1987) Section 34: some risk factors related to the annual incidence of cardiovascular disease and death in pooled biennial measurements. In: Kannel WB, Wolf PA, Garrison RJ (eds) Framingham heart study: 30 year follow-up, vol 87. US Department of Health and Human Services (NIH publication), Bethesda, pp 2703–2707

    Google Scholar 

  3. Woodward M, Brindle P, Tunstall Pedoe H (2007) Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC). Heart 93:172–176

    Article  PubMed  Google Scholar 

  4. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE. Eur Heart J 24:987–1003

    Article  PubMed  CAS  Google Scholar 

  5. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285:2486–2497

    Google Scholar 

  6. Pearson TA (2002) New tools for coronary risk assessment: what are their advantages and limitations? Circulation 105:886–892

    Article  PubMed  Google Scholar 

  7. Haffner SM (2006) The metabolic syndrome: inflammation, diabetes mellitus, and cardiovascular disease. Am J Cardiol 97:3A–11A

    Article  PubMed  CAS  Google Scholar 

  8. Langenberg C, Bergstrom J, Scheidt-Nave C, Pfeilschifter J, Barrett-Connor E (2006) Cardiovascular death and the metabolic syndrome: role of adiposity-signaling hormones and inflammatory markers. Diabetes Care 29:1363–1369

    Article  PubMed  CAS  Google Scholar 

  9. Libby P, Ridker PM (1999) Novel inflammatory markers of coronary risk: theory versus practice. Circulation 100:1148–1150

    Article  PubMed  CAS  Google Scholar 

  10. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR (2002) Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 347:1557–1565

    Article  PubMed  CAS  Google Scholar 

  11. Fuster V (1995) Elucidation of the role of plaque instability and rupture in acute coronary events. Am J Cardiol 76:24C–33C

    Article  PubMed  CAS  Google Scholar 

  12. McGovern PG, Pankow JS, Shahar E, Doliszny KM, Folsom AR, Blackburn H et al (1996) Recent trends in acute coronary heart disease: mortality, morbidity, medical care, and risk factors. N Engl J Med 334:884–890

    Article  PubMed  CAS  Google Scholar 

  13. Cheng KS, Mikhailidis DA, Hamilton G, Seifalian AM (2002) A review of carotid and femoral intima-media thickness as an indicator of the presence of vascular disease and cardiovascular risk factors. Cardiovasc Res 54:528–538

    Article  PubMed  CAS  Google Scholar 

  14. Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER et al (2008) Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force: endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 21:93–111

    Article  PubMed  Google Scholar 

  15. Nambi V, Chambless L, He M, Folsom AR, Mosley T, Boerwinkle E et al (2012) Common carotid artery intima-media thickness is as good as carotid intima-media thickness of all carotid artery segments in improving prediction of coronary heart disease risk in the Atherosclerosis Risk in Communities (ARIC) study. Eur Heart J 33:183–190

    Article  PubMed  Google Scholar 

  16. Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki- Torkko N et al (2003) Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 290:2277–2283

    Article  PubMed  CAS  Google Scholar 

  17. Anderson KM, Wilson PWF, Odell PM, Kannel WB (1991) An updated coronary risk profile: a statement for health professionals. Circulation 83:356–362

    Article  PubMed  CAS  Google Scholar 

  18. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97:1837–1847

    Article  PubMed  CAS  Google Scholar 

  19. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA et al (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation 112:2735–2752

    Article  PubMed  Google Scholar 

  20. Nasir K, Vasamreddy C, Blumenthal RS, Rumberger JA (2006) Comprehensive coronary risk determination in primary prevention: an imaging and clinical based definition combining computed tomographic coronary artery calcium score and National Cholesterol Education Program risk score. Int J Cardiol 110:129–136

    Article  PubMed  Google Scholar 

  21. Lester SJ, Eleid MF, Khandheria BK, Hurst RT (2009) Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis. Mayo Clin Proc 84:229–233

    Article  PubMed  Google Scholar 

  22. Mendoza F, Berman D, Rafii F, Gransar H, Wong N, Guerra M et al (2008) Does zero coronary or aortic calcium score predict the absence of carotid plaque? J Am Coll Cardiol 51:A152

    Google Scholar 

  23. Adolphe A, Cook LS, Huang X (2009) A cross-sectional study of intima-media thickness, ethnicity, metabolic syndrome, and cardiovascular risk in 2268 study participants. Mayo Clin Proc 84:221–228

    Article  PubMed  Google Scholar 

  24. Ferrières J, Elias A, Ruidavets JB, Cantet C, Bongard V, Fauvel J et al (1999) Carotid intima-media thickness and coronary heart disease risk factors in a low-risk population. J Hypertens 17:743–748

    Article  PubMed  Google Scholar 

  25. Folsom AR, Kronmal RA, Detrano RC, O’Leary DH, Bild DE, Bluemke DA et al (2008) Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med 168:1333–1339

    Article  PubMed  Google Scholar 

  26. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR et al (1997) Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 146:483–494

    Article  PubMed  CAS  Google Scholar 

  27. Folsom AR, Chambless LE, Ballantyne CM, Coresh J, Heiss G, Wu KK et al (2006) An assessment of incremental coronary risk prediction using C-reactive protein and other novel risk markers: the atherosclerosis risk in communities study. Arch Intern Med 166:1368–1373

    Article  PubMed  CAS  Google Scholar 

  28. Sun Y, Lin CH, Lu CJ, Yip PK, Chen RC (2002) Carotid atherosclerosis, intima media thickness and risk factors—an analysis of 1781 asymptomatic subjects in Taiwan. Atherosclerosis 164:89–94

    Article  PubMed  CAS  Google Scholar 

  29. Marrugat J, D’Agostino R, Sullivan L, Elosua R, Wilson P, Ordovas J et al (2003) An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. J Epidemiol Community Health 57:634–638

    Article  PubMed  CAS  Google Scholar 

  30. Liu JL, Hong Y, D’Agostino RB Sr, Wu Z, Wang W, Sun J et al (2004) Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study. JAMA 291:2591–2599

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

    Chung-Lieh Hung, Chih-Hsuan Yen, Yih-Jer Wu, Charles Jia-Yin Hou, Jen-Yuan Kuo & Hung-I Yeh

  2. Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan

    Helen L. Po

  3. Department of Health Industry Management, Kainan University, No 1, Kainan Road, Luzhu, Taoyuan County, 33857, Taiwan

    Chung-Lieh Hung & Syi Su

  4. The Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan

    Chung-Lieh Hung, Chun-Chun Liu & Syi Su

  5. Health Evaluation Center, Mackay Memorial Hospital, Taipei, Taiwan

    Chun-Chun Liu

  6. Department of Medical Laboratory Science and Biotechnology, Yuanpei University, Hsin Chu, Taiwan

    Chun-Chun Liu

  7. Mackay Medical College, New Taipei, Taiwan

    Yih-Jer Wu & Hung-I Yeh

Authors
  1. Chung-Lieh Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen L. Po
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chun-Chun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chih-Hsuan Yen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yih-Jer Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Charles Jia-Yin Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jen-Yuan Kuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hung-I Yeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Syi Su
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Syi Su.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (TIFF 311 kb)

Supplementary material 2 (TIFF 299 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hung, CL., Po, H.L., Liu, CC. et al. The utilization of carotid artery imaging beyond metabolic scores and high-sensitivity CRP in screening intermediate-to-high Framingham risk of asymptomatic Taiwanese population. Int J Cardiovasc Imaging 29, 765–775 (2013). https://doi.org/10.1007/s10554-012-0146-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-012-0146-x

Keywords

Search

Navigation