The Barcelona-Asymptomatic Intracranial Atherosclerosis study: Subclinical intracranial atherosclerosis as predictor of long-term vascular events.

BACKGROUND AND AIMS: Symptomatic intracranial atherosclerosis (ICAS) is associated with a high risk of stroke recurrence and occurrence of other vascular events. However, ICAS has been poorly studied from its asymptomatic stage. The objective of our study was to determine if subclinical intracranial atherosclerosis is associated with long-term incident vascular events in Caucasians. METHODS: The Barcelona-Asymptomatic Intracranial Atherosclerosis (AsIA) Study is a population-based study that enrolled 933 subjects with a moderate-high vascular risk and without history of stroke or coronary disease, and determined the prevalence of asymptomatic ICAS and associated risk factors. At baseline visit, carotid atherosclerosis and ICAS were screened by color-coded duplex ultrasound, and moderate-severe stenosis was confirmed by magnetic resonance angiography. At baseline, 8.9% of subjects had asymptomatic ICAS, of whom 3.3% were moderate-severe. In the longitudinal phase, subjects were prospectively followed-up to assess the incidence of a combined primary endpoint of vascular events (stroke, acute coronary syndrome and/or vascular death). RESULTS: After 7.17 years of follow-up, there were 51 incident cerebrovascular events (16 transient ischemic attacks, 27 ischemic, 8 hemorrhagic strokes), 63 incident coronary events and 23 vascular deaths. After multivariate Cox regression analyses adjusted by age, sex, vascular risk and presence of carotid plaques, ICAS was an independent predictor for overall vascular events (HR 1.83 [1.10-3.03], p = 0.020), and moderate-severe intracranial stenosis was also an independent predictor for cerebrovascular events (HR 2.66 [1.02-6.94], p = 0.046). CONCLUSIONS: Asymptomatic ICAS is independently associated with the incidence of future vascular events in our population. These findings might have implications for the development of primary prevention strategies.

El índice tobillo-brazo mejora la clasificación del riesgo cardiovascular: estudio ARTPER/PERART / Ankle-brachial index improves the classification of cardiovascular risk: PERART/ARTPER study

Introducción y objetivos. Las funciones de riesgo cardiovascular tienen una baja sensibilidad, pues frecuentemente los eventos cardiovasculares se producen en personas en riesgo bajo o intermedio. El objetivo de este trabajo es estudiar cómo el índice tobillo-brazo (ITB) reclasifica a estos pacientes. Métodos. Se realizó un estudio descriptivo transversal, multicéntrico (28 centros), con 3.171 pacientes de edad > 49 años seleccionados aleatoriamente. Se estudiaron variables demográficas, antecedentes y factores de riesgo cardiovasculares, ITB (patológico si era<0,9) y riesgo cardiovascular a 10 años con Framingham-Wilson, REGICOR y SCORE, con las siguientes categorías: bajo (Framingham<10%, REGICOR<5% y SCORE<2,5%), intermedio (10-19,9%, 5-9,9% y 2,5-4,9%, respectivamente) y alto (≥ 20%, ≥ 10% y ≥ 5%, respectivamente). Se reclasificó a los pacientes con riesgo bajo o intermedio a la categoría de riesgo alto si presentaban un ITB < 0,9. Resultados. Los pacientes con ITB < 0,9, comparados con los que lo tenían ≥ 0,9, eran significativamente mayores, con predominio de varones, peor perfil de antecedentes y factores de riesgo cardiovasculares y superior proporción de pacientes en riesgo alto, con Framingham-Wilson (el 42,7 contra el 18,5%), REGICOR (el 25,8 contra el 9,3%) y SCORE (el 42,2 contra el 15,9%). En varones la utilización del ITB supuso un aumento en la categoría de riesgo alto del 5,8% con Framingham-Wilson, el 19,1% con REGICOR y el 4,4% con SCORE. En mujeres fue del 78,6% con Framingham-Wilson, el 151,6% con REGICOR y el 50% con SCORE. Conclusiones. El ITB reclasifica a una importante proporción de personas hacia la categoría de riesgo alto, sobre todo en mujeres y con la función REGICOR(AU)

Introduction and objectives: The sensitivity of cardiovascular risk functions is low because many cardiovascular events occur in low- or intermediate-risk patients. The aim of the present study was to evaluate how the ankle-brachial index (ABI) reclassifies these patients. Methods: We conducted a descriptive, transversal, multicenter study (28 centers) of 3171 randomly selected patients aged >49 years. We studied demographic variables, clinical history and cardiovascular risk factors, ABI (defined as pathologic if <0.9) and 10-year cardiovascular risk with the Framingham- Wilson, REGICOR and SCORE equations, dividing risk into three categories: low (Framingham < 10%, REGICOR < 5% and SCORE < 2.5%, intermediate (10-19.9%, 5-9.9% and 2.5-4.9%, respectively) and high ( 20%, 10% and 5%, respectively). Low- or intermediate-risk patients were reclassified as high-risk if they presented ABI <0.9. Results: We compared patients with ABI <0.9 and patients with ABI 0.9 and found the former were significantly older, more frequently men, had a worse history and more cardiovascular risk factors, and included more high-risk patients than when the classification used Framingham-Wilson (42.7% vs. 18.5%), REGICOR (25.8% vs. 9.3%) and SCORE (42.2% vs. 15.9%) equations. In men, using ABI led to a 5.8% increase in the high-risk category versus Framingham-Wilson, a 19.1% increase versus REGICOR and a 4.4% increase versus SCORE. In women, the increases were 78.6% versus Framingham-Wilson, 151.6% versus REGICOR and 50.0% versus SCORE. Conclusions: The ABI reclassifies a substantial proportion of patients towards the high-risk category. This is particularly marked in women and by comparison with REGICOR scores(AU)

Ankle-brachial index improves the classification of cardiovascular risk: PERART/ARTPER Study.

INTRODUCTION AND OBJECTIVES: The sensitivity of cardiovascular risk functions is low because many cardiovascular events occur in low- or intermediate-risk patients. The aim of the present study was to evaluate how the ankle-brachial index (ABI) reclassifies these patients. METHODS: We conducted a descriptive, transversal, multicenter study (28 centers) of 3171 randomly selected patients aged >49 years. We studied demographic variables, clinical history and cardiovascular risk factors, ABI (defined as pathologic if <0.9) and 10-year cardiovascular risk with the Framingham-Wilson, REGICOR and SCORE equations, dividing risk into three categories: low (Framingham<10%, REGICOR<5% and SCORE<2.5%, intermediate (10-19.9%, 5-9.9% and 2.5-4.9%, respectively) and high (≥20%, ≥10% and ≥5%, respectively). Low- or intermediate-risk patients were reclassified as high-risk if they presented ABI <0.9. RESULTS: We compared patients with ABI <0.9 and patients with ABI ≥0.9 and found the former were significantly older, more frequently men, had a worse history and more cardiovascular risk factors, and included more high-risk patients than when the classification used Framingham-Wilson (42.7% vs. 18.5%), REGICOR (25.8% vs. 9.3%) and SCORE (42.2% vs. 15.9%) equations. In men, using ABI led to a 5.8% increase in the high-risk category versus Framingham-Wilson, a 19.1% increase versus REGICOR and a 4.4% increase versus SCORE. In women, the increases were 78.6% versus Framingham-Wilson, 151.6% versus REGICOR and 50.0% versus SCORE. CONCLUSIONS: The ABI reclassifies a substantial proportion of patients towards the high-risk category. This is particularly marked in women and by comparison with REGICOR scores.