Are We Getting Nearer to Screening for Atherosclerosis?

Case Presentation: A 48-year-old healthy man suffered a complex ankle fracture in a cross-country skiing accident that required orthopedic surgery. In the hospital, a routine 12-lead ECG showed a 1-mm ST depression in lead V5 to V6, which prompted a noninvasive coronary artery calcium test that had a high score. Therefore, a coronary arteriogram was done, disclosing 70% to 90% lesions in 3 major coronary arteries, which were balloon dilated. Thereafter, the ankle surgery was performed successfully. The patient admitted that he felt assured that, as a physically active nonsmoker with a normal total cholesterol value on a routine test years earlier, no need existed for medical or cardiac consultation despite his strenuous recreational activity.
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Apresentação: A 48-year-old saudável homem sofreu uma fractura num tornozelo complexo cruzada país esqui acidente que exigiu cirurgia ortopédica. No hospital, uma rotina de ECG mostrou de 1 mm ST depressão em V5 para V6, que levou uma artéria coronária escore de cálcio teste não invasivo que teve uma pontuação elevada. Portanto, uma coronária arteriograma foi feito, a revelação 70% a 90% as lesões em 3 grandes artérias coronárias, que foram balão dilatadas. Posteriormente, a operação do tornozelo foi realizada com sucesso. O paciente admitiu que sentiu garantiu que, de uma forma fisicamente ativos não fumante com um valor normal de colesterol total sobre uma rotina ensaio anos antes, não existia necessidade de consulta médica ou cardíaco não obstante a sua actividade recreativa extenuante.

An increased carotid intima-media thickness was measured noninvasively by ultrasonography in persons without clinical cardiovascular disease. Over a 6.2-year follow-up, older individuals with an increased carotid intima-media thickness were shown to have an increased risk of infarction.25 Iglesias and coworkers26 reached similar results in the Rotterdam Study. Using carotid intima-media thickness testing, Davis and coworkers27 identified not only older adults but also children and young adults with premature atherosclerosis long before clinical signs and symptoms developed. The authors considered carotid intima-media thickness a surrogate marker of the degree of atherosclerotic process. A meta-analysis of 8 relevant studies28 summarized that carotid intima-media thickness is a strong predictor of future vascular events and contains information beyond the classic cardiovascular risk factors. Despite these studies, major health insurance bodies consider this test for use in clinically asymptomatic individuals investigational.29


Discussão interessante no Circulation. Estamos prontos para o diagnóstico de aterosclerose? Note que no caso acima nenhum exame para constatar isquemia induzida foi realizado.