An exploration of potential approaches to improve the diagnosis of subclinical atherosclerosis in patients with high cardiovascular risk

PURPOSE: The search for optimal approaches to the diagnosis of subclinical atherosclerosis using a wide range of traditional and psychosocial risk factors (RFs), as well as clinical and instrumental diagnostic methods in patients (pts) with high or very high cardiovascular (CV) risk. METHODS: This cross-sectional study enrolled52 pts, aged 40 to 65 years with high or very high CV risk (5-9 and ≥10% by the Systematic Coronary Risk Estimation Scale [SCORE], respectively). All participants underwent cardiac computed tomography (CT)angiography and calcium scoring. Traditional RFs (family history of premature CVD, smoking, overweight/obesity and abdominal obesity, hypertension, type 2 diabetes mellitus, lipids parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and lipids-related markers (apolipoprotein A1, apolipoprotein B, ApoB/ApoA1 ratio), biomarkers of inflammation (high-sensitivity C-reactive protein [hs CRP], fibrinogen), indicator carbohydrate metabolism (glucose), ankle-brachial index, stress-test, carotid plaques according to ultrasound, arterial stiffness were evaluated in all pts. Psychological RFs were evaluated using Hospital Anxiety and Depression Scale and DS-14 for type D personality. RESULTS: All pts were divided into 2 groups according to the CT angiography results: pts in the main group (n=21) had any non-obstructive lesions or calcium score >0, pts in the control group (n=31) had intact coronary arteries. The groups did not differ in age or gender. It was found that patients with subclinical atherosclerosis significantly more often have a very high (≥10%) CV risk (42.9% vs.16.3%, p<0.05), a long (≥5 years) history of arterial hypertension (47.6% vs. 12.9% , p<0.01) and longer duration of antihypertensive therapy (61.9% vs. 29.0%, p<0.05), higher heart rate in rest (87. ± 14 vs. 77 ± 10 beats/min, p<0.01), increased arterial stiffness according to aortic pulse wave velocity (85.7% vs. 61.3%, p<0.05) and high level of hs-CRP (100% vs. 90.3%, p<0.05). CONCLUSION: Using in routine clinical practice of additional anamnestic (hypertension lasting ≥ 5 years and the intake of any antihypertensive drugs) and clinical-instrumental parameters (high heart rate in rest, hs CRP and arterial stiffness in pts with high and very high CV risk increases effectiveness of early detection of subclinical atherosclerosis.