Argentine researchers have just published a work that sheds light on the
progression of cardiovascular disease
.
The results are key to the implementation of
preventive policies
that anticipate the consummation of cardiac events such as
heart attacks
.
The conclusions are surprising especially in the group of
young and healthy adults
.
The work was led by cardiologists Fernando Botto and Sebastián Obregón, at the Austral University Hospital.
The universe studied was
5,775
presumably healthy patients, that is, they had not had any cardiac event at the time of the study.
They measured
the level of atherosclerosis in two arteries with
Doppler ultrasound : the
carotid
and the
femoral
.
“Clinical guidelines recommend the measurement of arterial plaque load by vascular ultrasound as a risk modifier in
low or moderate risk
individuals without known atherosclerotic cardiovascular disease,” says the text published in the journal High Blood Pressure and Cardiovascular Prevention.
The work, titled “Prevalence and burden of carotid and femoral atherosclerosis in people without known cardiovascular disease in a large community hospital in South America,” evaluated by age and sex the burden of subclinical atherosclerosis and its
association with risk factors
in people
over 30 years of age
without declared cardiovascular disease.
“We found a prevalence of between
15 and 20 percent of plaque
from the age of 30,” says Botto in conversation with
Clarín
.
The Austral Hospital is a health center that serves the middle class public, which has prepaid or social insurance health coverage.
61 percent of those evaluated were men, with an average age of
51.3 years
.
The results indicate that the prevalence of plaque was, overall,
51 percent
in the carotid arteries,
39.3
percent in the femoral arteries, 62.4 percent in the carotid or femoral arteries, and 37.6 percent in the percent in none.
Starts before age 40
“The prevalence of plaques showed an increasing trend with age, being higher in men than in women and starting before the age of 40, both in the carotid and femoral locations.
There was also an
increasing prevalence of plaques
according to the number of
risk factors
and, interestingly, we found a high prevalence of plaques in subjects with 0 or 1 classic risk factors (hypertension, obesity, diabetes),” the researchers indicate in the work.
They found that the prevalence of plaque is greater in men (it occurs around 8 years earlier than in women) and that “it begins
before the fourth decade
of life and increases with age.”
It adds: “Despite a significant association with classic risk factors, a significant number of subjects with
low risk factors
were diagnosed with atheromatous plaque.”
Botto, current head of Clinical Research at the Cardiovascular Institute of Buenos Aires (ICBA), explains why these results are important: “Doppler ultrasound of the carotid and femoral arteries is requested by doctors to see if there is
a severe obstruction
, which ends in a stent or carotid surgery.
The typical report usually says that no hemodynamically significant obstructions are observed.
And a small atheroma is observed at the bifurcation.
But our interest is to observe
non-severe cases to prevent
.”
An ultrasound image of the carotid artery showing an atheromatous plaque in the bifurcation, in a 45-year-old person.
So, according to Botto, these studies are valuable to observe
signs in the
patient's current health that give an idea of how that person may be
over the years
.
“If I saw a plate of 3 square millimeters, and I found four similar small plates, the issue is the
sum of surface in the light field
.
These patients do not have severe obstructions.
But the key is prevention, the obsessive search for those inserts.”
The expert explains that “with the common Doppler ultrasound, the opportunity
to know if someone has a low or high burden of atherosclerosis
is lost .
This burden is associated with a
worse prognosis
over five or six years of follow-up .
The type that has more tartar in the pipe has more risk in the future.
And there are studies that correlate it with greater coronary heart disease.
The important thing is
to try to avoid the first
cardiac event.”
The cardiologist emphasizes that there are patients “like the chubby, sedentary 50-year-old smoker, who you already know is at risk.
I challenge that one, he surely has a high plaque load.
That is, from the clinical scores it can be presumed that he has atherosclerosis.
But then there is the 35-year-old super athlete who doesn't smoke, and there you find everything.
Without obvious risk factors and atherosclerosis
.
I have seen 45-year-old girls, models, who have the carotid arteries of an 85-year-old woman.
Lifestyle and genetics
For this reason, Botto points out that a large part of the challenges are in improving lifestyle, but that there is
an important genetic part
.
“For certain people, the Doppler ultrasound becomes a genetic test.
It is exciting and incredible to see physical education teachers or personal trainers at 35 years old
with cholesterol plaques
.
They are small there.
But at that age it doesn't tell you about a future full of roses and carnations."
"For certain people, the Doppler ultrasound becomes a genetic test," says cardiologist Fernando Botto.
What's more, the cardiologist speaks of atherosclerosis as "a childhood condition." And remember that there are dozens of statistics, among them those of soldiers killed in the Korean and Vietnam wars, 21-year-olds, whose autopsies showed that
one out of every four
had an atheroma in the coronary arteries. Other studies show that
one in every 7
high school boys already has a coronary atheroma."
Botto recalls that in Argentina the average age of
acute heart attacks in men is 59 years
: “This means that before that age (between 40 and 60 years) half of the heart attacks have already occurred.
The key is to prevent them
since men still believe they are Ironman, when they are between 20 and 50 years old and do not go to the cardiologist.
They only go if they have a heart attack or a friend has one.
Mortality from heart attacks is 40 percent.
If I want to prevent it, I have to
start at age 25 or 30
, earlier than what the guidelines say, which is after age 40.”
He explains that “between the ages of 30 and 35, a man should undergo an evaluation with a physical examination, electrocardiogram, blood test, cholesterol, waist circumference and see what lifestyle he leads.
If there is a risk factor, even one, I recommend
doing a carotid femoral doppler
.
The number of heart attacks in recent years has not changed because we are
focusing on the problem incorrectly
.
We must start earlier with prevention.
And act accordingly, changing lifestyle or giving medication when necessary.”
P.S.