Should we measure carotid intima media thickness in any cardiac risk assessment?

Measuring maximum intima-media wall thickness of the internal carotid (neck) artery may boost the predictive power of Framingham risk scores as per Dr Joseph Polak, of Tufts University, and colleagues who reported their findings in the New England Journal of Medicine.

1. Thickening in both arteries is used as a surrogate measure of atherosclerosis.

2.   In the common carotid it manifests as diffuse arterial wall thickening

3.    In  the internal carotid artery, it's a surrogate for focal atherosclerotic plaque

4.   Both are recognized tools for cardiovascular risk assessment

5.   To clarify the issue, Polak and colleagues analyzed data from 2,965 patients in the Framingham Offspring Study who were followed for an average of 7.2 years, and 296 of them had a cardiovascular event during that time.

6.   Plaque is defined as an intima-media thickness of more than 1.5 mm in the internal carotid artery. Plaque in ICA is a significant predictor of cardiovascular events.

7.    Recent American College of Cardiology and American Heart Association guidelines give common carotid artery intima-media thickness a level IIa recommendation for risk evaluation -- the same level as ankle-brachial index and coronary artery calcium scoring.

8.    Intima-media thickness of the internal carotid artery should be measured in addition to the thickness of the common carotid artery for purposes of cardiovascular risk assessment.

Dr KK Answers : Can we allow low dose aspirin holidays?

Those at risk of heart attack or other cardiovascular events taking a low dose aspirin holiday can increase their risk of acute heart attack as per a large case-controlled study of 39513 patients aged 50-84 by Dr Luis Garcia Rodriguez, of the Spanish Centre for Pharmacoepidemiologic Research in Madrid and published in British Medical journal.

Compared with those taking aspirin, individuals prescribed aspirin for secondary prevention who had recently discontinued the drug had a significantly increased risk of nonfatal heart attacks or death from coronary heart disease combined and nonfatal heart attacks

Aspirin holiday can cause four more cases of nonfatal heart attacks for every 1,000 patients over a period of one year.

The current American Heart Association/American College of Cardiology practice guidelines recommend 75 mg to 162 mg of aspirin as low dose aspirin per day.

Dr KK Answers: Should we measure carotid intima media thickness in any cardiac risk assessment?

Measuring maximum intima-media wall thickness of the internal carotid (neck) artery may boost the predictive power of Framingham risk scores as per Dr Joseph Polak, of Tufts University, and colleagues who reported their findings in the New England Journal of Medicine.

1.       Thickening in both arteries is used as a surrogate measure of atherosclerosis.

2.       In the common carotid it manifests as diffuse arterial wall thickening

3.       In  the internal carotid artery, it's a surrogate for focal atherosclerotic plaque

4.        Both are recognized tools for cardiovascular risk assessment

5.        To clarify the issue, Polak and colleagues analyzed data from 2,965 patients in the Framingham Offspring Study who were followed for an average of 7.2 years, and 296 of them had a cardiovascular event during that time.

6.        Plaque is defined as an intima-media thickness of more than 1.5 mm in the internal carotid artery

7.       Plaque in ICA is a significant predictor of cardiovascular events.

8.        Recent American College of Cardiology and American Heart Association guidelines give common carotid artery intima-media thickness a level IIa recommendation for risk evaluation -- the same level as ankle-brachial index and coronary artery calcium scoring.

9.        Intima-media thickness of the internal carotid artery should be measured in addition to the thickness of the common carotid artery for purposes of cardiovascular risk assessment.