SUBCLINICAL ARTERIOSCLEROSIS SCREENING - THE PAP PEA STUDY

Noninvasive screening of subclinical atherosclerosis is possible with ultrasonic biopsy (UB) performed with high resolution ultrasound scann ing. Five UB classes have been identified, each class corresponding to a different incidence of cardiovascular events (CVE) in 4 years and s ilent coronary ischemia (SCI). In a study including 2230 asymptomatic subjects 3 risk groups were defined. In the low risk group (class I an d II; 82.01% of the population sample) the incidence of CVI and SCI wa s zero. These subjects may be seen again after 3 years. In the moderat e risk group (class II and IV; 13.3%) monitoring and early interventio n may be needed. In the high risk group (class V; 4.6%) prophylaxis or treatment may be necessary. The screening is effective, simple and ma y be organised at very low cost-i.e. 30.000 asymptomatic subjects may be scanned at the cost of 100.000 ECU. Each scan, including carotid an d femoral bifurcations, may be performed in 15 minutes. In our communi ties this cost is equivalent to the average cost of a single major str oke or major coronary ischemic event in a working adult aging between 45 and 60. Organization problems and the fragmentation of competences has prevented the evolution of atherosclerosis screening. The problem can be solved organising a network including epidemiologists, angiolog ists and cardiovascular surgical centres where all phases of atheroscl erosis may be studied and detected, progression prevented and complica tions treated with a global vision of the disease.