|
Arteris stands for new concepts in cardiovascular risk prediction using carotid plaque imaging and conventional cardiovascular risk factors. Our database has collected over 8’000 healthy individuals from Germany and Switzerland that are available for further analysis. There is a missing piece of knowledge about the sensitivity of coronary risk calculators to detect advanced atherosclerosis. We found very low sensitivities (1). At the clinical level, cutoffs of coronary risk determine the initiation of preventive therapies, e.g. with statins, and these cutoffs determine the sensitivity of a clinical action. Current thresholds lead to a virtual obsolescende of coronary risk prediction in subjects aged 40-65 years, because the ability to detect high risk individuals using established treatment thresholds is below 30%.
One reason for the choice of high cutoffs for aggressive primary prevention is a mislead discussion about costs (2). Arteris cohorts are currently used to evaluate the clinical usefulness of coronary risk thresholds to detect younger subjects with a high coronary risk defined by carotid plaque imaging.
The problem of low detection rates of subjects at risk is especially pertinent in women. Old arteries are far more frequently missed in women than in men. This creates an ethically problematic inequity for women (the paper is now in the submission process by August 2017).
|
The largest atherosclerosis imaging patient group of central Europe and Switzerland