Data presented at the 26th World Congress of the International Union of Angiology (IUA), Sydney, Australia, highlights the benefit of ultrasound screening in detecting early signs of vascular disease in otherwise' low' to 'moderate' risk asymptomatic individuals - with the potential to half the incidence of stroke and heart attacks1.
Each year, 20 million people in middle and old age die due to vascular disease. Yet one-in-three people developing MI will not exhibit any of the conventional risk factors2, and 80% of strokes occur without warning in asymptomatic patients3.
Early signs of vascular disease such as atherosclerotic plaques and narrowing of the arteries are indicators of risk and can be easily detected using ultrasound. Research and analysis presented at the IUA by several leading cardiovascular specialists, shows identifying asymptomatic individuals at risk as early as possible, and targeting them for aggressive risk factor modification, can dramatically reduce morbidity and mortality from myocardial infarction and stroke by 50%1.
New research also shows that a significant proportion of the population may have early signs of vascular disease. Data presented from a screening study in Australia showed the general prevalence of significant carotid vessel disease was 1.7%, and the prevalence of AAA (where the dilatation of artery is > 3cm) was 2% with some having a large (>5 cm) life-threatening aneurysm that carries more than 20% risk of rupture in the next 12 months.
The prevalence of 2% exceeds the 1% threshold typically used as a guideline to provide cost-effective screening in the general population, and supports unrestricted use of ultrasound screening to detect AAA and other cardiovascular diseases.
Data was also presented from an epidemiological study carried out by Imperial College London and Life Line Screening, looking at demographics and risk factors in 2419 patients with AAA detected by ultrasound screening. Carotid artery disease, history of MI, diabetes, hyperlipidaemia, smoking and family history were shown to be independent risk factors for AAA in men.
A significant percentage of AAAs were found among males younger than 65. This suggests limitations in the current screening recommendations where males in the UK over the age of 65 are invited for screening by the NHS. Using the 1% threshold or greater to provide cost-effective screening, all women aged over 80 and women aged 70-79 who have two or more risk factors would benefit from being invited for screening (prevalence 0.98-1.25%).
"Atherosclerotic arterial disease which is responsible for heart attacks and strokes, develops slowly and silently for many years before it becomes manifest as disease," said Professor Andrew Nicolaides, Emeritus Professor of Vascular Surgery at Imperial College London.
"Its detection and silent progression can be recorded accurately with ultrasound scans. The presence of such deposits places an individual at high risk yet intervention with modern medical therapy can reduce the risk of heart attacks and strokes by 50%."
According to Dr Mohsen Chabok, Medical Research Physician, Life Line Screening UK, "Arterial imaging of the carotid peripheral circulation can be used to further refine risk based on Framingham Risk Scoring. More accurate diagnosis allows more targeted treatment. I think it is time to seriously consider the value of ultrasound screening for vascular disease in asymptomatic patients."
Other significant data presented at IUA showed that patients with asymptomatic carotid artery disease are at 200% greater risk of developing chronic kidney disease (CKD). High blood pressure, carotid artery disease, peripheral artery disease, and history of stroke or heart disease double the risk of developing CKD.
This new research and interpretation of existing data and current approaches to prevention and treatment of vascular disease was presented at a special session of the IUA by members of the Scientific Advisory Network on behalf of Life Line Screening.