Preclinical atherosclerosis and cardiovascular events: Do we have a consensus about the role of preclinical atherosclerosis in the prediction of cardiovascular events?

• Published in: Atherosclerosis 2022-05, Vol.348, p.25-35
• Main Authors: Poredoš, Pavel, Cífková, Renata, Maier, Jeanette Anne Marie, Nemcsik, Janos, Šabovič, Mišo, Jug, Borut, Ježovnik, Mateja Kaja, Schernthaner, Gerit Holger, Antignani, Pier Luigi, Catalano, Mariella, Fras, Zlatko, Höbaus, Clemens, Nicolaides, Andrew N., Paraskevas, Kosmas I., Reiner, Željko, Wohlfahrt, Peter, Poredoš, Peter, Blinc, Aleš
• Format: Article
• Language: English
• Subjects: Ankle-brachial index; Arterial stiffness; Atherosclerosis - diagnosis; Calcium score; Cardiovascular Diseases - diagnosis; Carotid Arteries - diagnostic imaging; Carotid Intima-Media Thickness; Circulating biomarkers; Consensus; Endothelial dysfunction; Humans; Intima-media thickness; Pulse Wave Analysis; Risk Factors
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2022.03.030

Atherosclerosis has a long preclinical phase, and the risk of cardiovascular (CV) events may be high in asymptomatic subjects. Conventional risk factors provide information for the statistical probability of developing CV events, but they lack precision in asymptomatic subjects. This review aims to summarize the role of some widely publicized indicators of early atherosclerosis in predicting CV events. The earliest measurable indicator of the atherosclerotic process is endothelial dysfunction, measured by flow-mediated dilation (FMD) of the brachial artery. However, reduced FMD is a stronger predictor of future CV events in patients with existing CV disease than in apparently healthy persons. Alternatively, measurement of carotid artery intima-media thickness does not improve the predictive value of risk factor scores, while detection of asymptomatic atherosclerotic plaques in carotid or common femoral arteries by ultrasound indicates high CV risk. Coronary calcium is a robust and validated help in the estimation of vascular changes and risk, which may improve risk stratification beyond traditional risk factors with relatively low radiation exposure. Arterial stiffness of the aorta, measured as the carotid-femoral pulse wave velocity is an independent marker of CV risk at the population level, but it is not recommended as a routine procedure because of measurement difficulties. Low ankle-brachial index (ABI) indicates flow-limiting atherosclerosis in the lower limbs and indicates high CV risk, while normal ABI does not rule out advanced asymptomatic atherosclerosis. Novel circulating biomarkers are associated with the atherosclerotic process. However, because of limited specificity, their ability to improve risk classification at present remains low. [Display omitted] •Traditional risk factors for cardiovascular (CV) disease inform on the probability of developing atherosclerosis and related CV events.•Detecting preclinical atherosclerosis enables the identification of individuals with ongoing atherosclerosis.•Preclinical atherosclerosis can be identified by functional/morphologic deterioration of the arterial wall or by circulating biomarkers.•The predictive value of indicators of preclinical atherosclerosis for future CV events is not completely elucidated.•Ankle-brachial index, calcium score, and asymptomatic plaques may improve risk stratification for CV events beyond traditional risk factors.