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Researchers at Baylor College of Medicine have shown how using ultrasound to determine the thickness of the artery wall and presence of plaque in the artery wall can be used to pinpoint who is at highest risk for having a heart attack.

Doctors everywhere have another tool to further improve the prediction and prevention of heart attacks. The findings can be found in the current edition of the Journal of the American College of Cardiology.

Artery wall thickness, plaque

"Doctors have suspected that using ultrasound to measure artery wall thickness and to determine the presence of plaque can help better predict heart attacks, but there has not been any comprehensive reports that show how to add the measurements to traditional risk prediction schemes to form accurate predictions," said Dr. Vijay Nambi, assistant professor of medicine – atherosclerosis and vascular medicine at BCM and lead author on the study. "Our latest study does just that, and we believe that it will impact future guidelines for heart disease risk prediction."

To determine heart disease risk doctors use a score based on traditional risk factors, which include age, gender, HDL cholesterol (good cholesterol), total cholesterol, hypertension and smoking.

In the current study, Nambi and his colleagues added another factor – the presence of plaque in the carotid arteries and the thickness of the carotid arteries. The results showed they were able to better predict heart attacks in those in the low and intermediate risk levels.

Target those at risk

"Since the majority of heart attacks happen to those considered low to intermediate risk, we need to have additional information to help us target those most at risk in those categories," said Nambi, who is also with the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart and Vascular Center.

Once the thickness of the carotid artery and the presence of plaque was added to the traditional risk factors, around 23 percent of the more than 13,000 people in the study were reclassified into a higher or lower risk category.

For example, 2,340 people were considered low-intermediate risk. Once the thickness of the artery wall and the presence of plaque were included in the risk score, 22 percent were reclassified as low risk, while 15 percent were now at a higher risk.

Plaque matters

Participants were already taking part in the Atherosclerosis Risk in Communities study, a large-scale study designed to investigate the etiology and natural history of atherosclerosis. The ultrasound s were performed between 1987 to 1989. Researchers have been following up with patients to determine who suffered heart attacks.

Source: BCM

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