Impact of atherosclerosis detection by carotid ultrasound on physician behavior and risk-factor management in asymptomatic hypertensive subjects

Abstract

Background: There are limited data regarding the impact of atherosclerosis detection by carotid ultrasound (CUS) on physician prevention efforts and risk-factor management for cardiovascular disease.

Hypothesis: Atherosclerosis detection by CUS in asymptomatic hypertensive patients would lead to physician prevention efforts, including target low-density lipoprotein cholesterol (LDL-C) level and prescription. Also, it may improve risk-factor management.

Methods: A total of 347 asymptomatic hypertensive subjects (age 61 ± 8 years, 189 men) were prospectively recruited from 22 hospitals. Prior to CUS, physicians were surveyed regarding target LDL-C level. After CUS, patients were classified into positive CUS (n = 182) and negative CUS (n = 165) groups based on CUS results. Physicians were resurveyed to assess whether the initial target LDL-C goals were changed. At 6 months, cardiovascular risk-factor modification status was reassessed.

Results: The proportion of lowered target LDL-C levels was significantly larger in the positive CUS group than in the negative CUS group (52% vs 23%, P < 0.001). These results were observed even in subjects who had low and moderate risk according to National Cholesterol Education Program-Adult Treatment Panel III guidelines. Lipid-lowering agents were similarly added or switched to another class in both groups (7% in the positive CUS group vs 11% in the negative CUS group, P = 0.153). LDL-C was significantly decreased in the positive CUS group (Δ = -24 ± 38 mg/dL, P < 0.001), whereas it was not significantly decreased in the negative CUS group (Δ = -6 ± 31 mg/dL, P = 0.105).

Conclusions: Atherosclerosis detection by CUS lowered physicians' target LDL-C level and improved cardiovascular risk management in terms of LDL-C reduction.

Figure 1

Changes in target LDL‐C after CUS examination. After confirmation of CUS examination results, the proportion of lowered target LDL‐C level was significantly larger in the positive CUS group compared with the negative CUS group (52% vs 23%, P < 0.001). Abbreviations: CUS, carotid ultrasound; LDL‐C, low‐density lipoprotein cholesterol.

Figure 2

Changes in target LDL‐C after CUS examination stratified by risk according to NCEP‐ATP III guidelines. The proportion of lowered target LDL‐C level was significantly larger in the positive CUS group compared with the negative CUS group, both in the low‐risk and moderate‐risk patients, according to NCEP‐ATP III guidelines. Abbreviations: CUS, carotid ultrasound; LDL‐C, low‐density lipoprotein cholesterol; NCEP‐ATP III, National Cholesterol Education Program–Adult Treatment Program III.