EARLY DIAGNOSIS OF SILENT ATHEROSCLEROSIS AND DETECTION OF CARDIOVASCULAR RISK-FACTORS - A NEW STRATEGY FOR CARDIOVASCULAR-DISEASE PREVENTION

The authors present a new strategy for cardiovascular disease preventi on based on risk factor detection in occupational medicine and silent atherosclerosis detection in a specialized investigation centre. Emplo yees from several firms in the Paris region were searched, in their wo rking place, for cardiovascular risk factors, including blood choleste rol measurement. The subjects at risk thus selected underwent non-inva sive explorations aimed at an early detection of silent atherosclerosi s. Extracoronary plaques in the carotid, aorta and femoral arteries we re detected by high-resolution ultrasonography, and coronary calcifica tions by ultrafast CT. The prevalence of arterial lesions and their re lationship with risk factors were analysed in a subgroup of 208 untrea ted male subjects with high blood cholesterol level: 74 percent of the se subjects had extracoronary plaques and 65 percent had coronary calc ifications. This high prevalence of silent arterial lesions suggested that hypercholesterolaemia, even when moderate, has an early but incon sistent atherogenic effect. Moreover, extracoronary plaques and corona ry calcifications were related to risk factors other than blood lipids , and among these factors age was predominant. The simultaneous detect ion of extracoronary and coronary lesions has demonstrated that extrac oronary ultrasonography of several arteries is a good diagnostic test predicting the presence of coronary calcifications in the absence of c oronary symptoms. Detection of silent atherosclerosis in subjects at r isk therefore is an original and helpful complement to risk factor det ection. It should better refine and individualize the diagnosis of ris k and evaluate the effects of preventive cardiovascular treatments on atherosclerosis.