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Ultraschalluntersuchung der A. carotis zur verbesserten Vorhersage kardiovaskulärer Ereignisse und der Wirkung einer Statinbehandlung bei fortgeschrittener Atherosklerose

Eine Beobachtungsstudie

Ultrasound examination of the carotid artery for improved prediction of cardiovascular events and the effect of statin treatment in advanced atherosclerosis

An observational study

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Zusammenfassung

Hintergrund

Eine fortgeschrittene Atherosklerose der Halsschlagader ist mit einem hohen Risiko für Herz-Kreislauf-Erkrankungen verbunden. Es wurde untersucht, ob der Ultraschall eine bessere Vorhersage kardiovaskulärer Ereignisse im Vergleich zum PROCAM(Prospective Cardiovascular Münster Study)-Score ermöglicht und ob die Behandlung von Probandinnen und Probanden mit fortgeschrittener Atherosklerose mit Statinen die Prognose verbessert.

Methode

Von 2009 bis 2016 wurden 4482 Probandinnen und Probanden (41 % Frauen) im Alter von 35 bis 65 Jahren ohne Zeichen einer kardiovaskulären Erkrankung mit Ultraschall an der A. carotis untersucht. Es wurden die Summe aller Plaqueflächen („total plaque area“, TPA) und die maximale Plaquedicke gemessen. Mit dem PROCAM-Score wurde das kardiovaskuläre Risiko bestimmt.

Ergebnisse

Die mittlere Nachbeobachtungszeit betrug 77 Monate (6,4 Jahre) für die Männer und 74 Monate (6,2 Jahre) für die Frauen. Bei 131 (3,4 %) der 3833 Probandinnen und Probanden mit Follow-up-Daten traten Ereignisse (Herzinfarkt, ischämischer Schlaganfall, CABG [„coronary artery bypass grafting“], perkutane transluminale Koronarangioplastie [PTCA]) auf. Die Vorhersage von kardiovaskulären Ereignissen war mit dem Ultraschall besser als mit dem PROCAM-Score. Mit dem Ultraschall wurden 79,4 % von 131 Ereignissen vorhergesagt und mit dem PROCAM-Score 22,9 %. Eine Behandlung der Probandinnen und Probanden mit fortgeschrittener Atherosklerose (Typ III, IVb) mit einem Statin verbesserte die Prognose signifikant. Die Ereignisrate betrug bei Männern und Frauen in der behandelten Gruppe 12,6 % versus 31,5 % (p < 0,0001) in der unbehandelten Gruppe. Die Mortalität (jeglicher Ursache) war bei den Männern bei einer Behandlung mit Statinen signifikant geringer (p = 0,0148).

Schlussfolgerung

Die Vorhersage kardiovaskulärer Ereignisse war mit der Messung der Plaquelast besser als mit dem PROCAM-Score. Eine Behandlung mit Statinen bei Probanden mit fortgeschrittener Atherosklerose der Halsschlagader (Typ-III- bis -IVb-Befund im Ultraschall) verbesserte die Prognose in einer nichtrandomisierten Beobachtungsstudie signifikant.

Abstract

Background

Advanced atherosclerosis of the carotid artery is associated with a high risk of cardiovascular diseases. It was investigated whether ultrasound provides a better prediction of cardiovascular events compared to the prospective cardiovascular Münster study (PROCAM) score and whether treatment of subjects with advanced atherosclerosis with statins improves the prognosis.

Method

Between 2009 and 2016 a total of 4482 subjects (41% women) aged 35–65 years with no signs of cardiovascular disease underwent carotid artery ultrasound examination. Total plaque area (TPA) and maximum plaque thickness were measured. The PROCAM score was used to determine the cardiovascular risk.

Results

The median follow-up time was 77 months (6.4 years) for the men and 74 months (6.2 years) for the women. Events, such as myocardial infarction, ischemic stroke, coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA), occurred in 131 (3.4%) of the 3833 subjects with complete follow-up data. The prediction of cardiovascular events was better with ultrasound than with the PROCAM score. Ultrasound predicted 79.4% of 131 events and the PROCAM score predicted 22.9%. Treatment of subjects with advanced atherosclerosis (types III, IV b) with a statin significantly improved the prognosis. The event rate was 12.6% in men and women in the treated group vs. 31.5% (p < 0.0001) in the untreated group. Mortality (from any cause) was significantly lower in men treated with statins (p = 0.0148).

Conclusion

The prediction of cardiovascular events was better with plaque burden measurements than with the PROCAM score. Treatment with statins in subjects with advanced carotid atherosclerosis (types III–IV b findings on ultrasound) significantly improved the prognosis in a nonrandomized observational study.

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Authors and Affiliations

  1. BAD Gesundheitsvorsorge und Sicherheitstechnik GmbH, Zentrum Koblenz, Koblenz, Deutschland

    Ansgar Adams

  2. Innere Medizin – Kardiologie, Gemeinschaftsklinikum Mittelrhein gGmbH, Standort Kemperhof, Koblenz, Deutschland

    Waldemar Bojara

  3. Vascular Risk Foundation (Varifo), Olten, Schweiz

    Michel Romanens

  4. BAD Gesundheitsvorsorge und Sicherheitstechnik GmbH, Zentrum Koblenz, Bubenheimer Bann 4, 56070, Koblenz, Deutschland

    Ansgar Adams

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  1. Ansgar Adams
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Correspondence to Ansgar Adams.

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Interessenkonflikt

A. Adams, W. Bojara und M. Romanens geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen und Auswertungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt.

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Adams, A., Bojara, W. & Romanens, M. Ultraschalluntersuchung der A. carotis zur verbesserten Vorhersage kardiovaskulärer Ereignisse und der Wirkung einer Statinbehandlung bei fortgeschrittener Atherosklerose. Herz 49, 60–68 (2024). https://doi.org/10.1007/s00059-023-05197-z

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