Ultrasound screening reveals unknown cardiovascular risk in women

By Edward Susman

September 12, 2006 -- Sonographic screening can correctly identify women who may be at risk of heart disease or stroke, especially when traditional risk assessment methods fall short, according to a presentation at the 2006 European Society of Cardiology's World Congress of Cardiology in Barcelona, Spain.

While the Framingham risk score (FRS) system correlates well with men who undergo ultrasound examinations of the carotid arteries and other vascular beds, it does not appear to work as well in women, said study author Dr. John Postley, Jr., an assistant clinical professor of medicine at Columbia University in New York City.

Instead, handheld ultrasound exams can give physicians a better idea as to whether a woman at even the lowest risk for heart disease may still have potential precursors to a heart attack, he said.

For this study, Postley looked 120 untreated patients, 50 of whom were women. They all underwent sonographic evaluation for the presence and type of carotid and femoral arterial bifurcation plaque (Titan; SonoCalc software, SonoSite, Bothell, WA). Common carotid intimal medial thickness (CIMT) was also measured.

A sonographic exam is capable of detecting differences of one-tenth of a millimeter of thickness of the intimal layer of the artery, Postley explained. The findings on ultrasound were then correlated with the individual's FRS.
According to the results, 72% of the women had low FRS for cardiovascular disease, yet half the women in the study showed evidence of plaque and thickening of the endothelial lining of the carotid artery.

When CIMT measurements were divided according to gender, there was no correlation for average CIMT or maximum CIMT among the women, Postley said, while there was high correlation among the men.

"Clearly, a better method for risk-stratifying patients is needed so that preventive treatment can begin for those who need it most," Postley wrote in his poster presentation. "Screening for carotid intimal medial thickness with vascular ultrasound can uncover at-risk patients with greater accuracy than traditional methods, and should allow for earlier intervention to prevent progression of disease."
"Screening vascular ultrasound analysis produces a different pattern of risk assessment than does traditional Framingham risk analysis, particularly in women," Postley added.
He suggested that using ultrasound as an additional screening tool could identify more women at risk of cardiovascular events.

"I would expect that private-care physicians -- either a family doctor or doctors who specifically care for women -- would refer their patients to radiologists to perform these ultrasound studies," he said.
Commenting on the study, Dr. Sid Smith, a professor medicine at the University of North Carolina in Chapel Hill, said more studies were needed before recommendations could be made about ultrasound screening. Smith, who is also a spokesman for the American Heart Association, said that future studies would have to show that the findings of intimal thickening and plaque streak in women do later correlate with adverse events, and that treating these women, on the basis of those findings, reverses the risk.

By Edward Susman
AuntMinnie.com contributing writer
September 12, 2006