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5381 - Surrogate Measures of Atherosclerosis and...

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Surrogate Measures of Atherosclerosis and Implications for Evaluating Cardiovascular Risk Nathan D. Wong, Ph.D., F.A.C.C. Associate Professor and Director Heart Disease Prevention Program University of California, Irvine
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Why use surrogate measures? CHD events often occur with no clinical history and often normal risk factors (e.g., total cholesterol is a poor predictor) Most heart attacks result from coronary lesions of less than 50% stenosis, often undetectable by traditional methods (exercise test, angiogram) Subclinical atherosclerosis (carotid IMT, ABI, CAC?) predicts coronary events Need to identify disease early enough to intervene to prevent clinical events
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Features of Using Surrogate Measures of Atherosclerosis Use as intermediate endpoints rather than waiting until hard endpoints occur May have implications for identifying and tracking earlier, subclinical disease Compared to clinical event studies, studies of surrogate endpoints are lower cost, require fewer subjects, less-follow-up Use to follow progression of disease and effects of medical intervention
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Use of Coronary Angiography in Early Studies of Surrogate Endpoints The first trials of surrogate endpoints in the late 1980’s involved coronary angiography Cholesterol Lowering Atherosclerosis Study (CLAS) used a qualitative angiographic scoring in CABG pts studied 2 years apart. FATS and Lifestyle Heart Trial: Quantitative Coronary Angiography Coronary angiography is expensive, may underestimate disease, examines only selected segments, limited to CAD patients
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Primary Modalities for Measuring Atherosclerotic Burden Carotid B-mode ultrasonography: intimal medial thicknesses CT (EBT or multislice detectors): coronary calcium score or volume Magnetic resonance imaging of carotid plaques: vessel wall area Intravascular ultrasound (invasive) Brachial ultrasound
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  • Fall '10
  • Staff
  • Atherosclerosis, right coronary artery, coronary calcium, Early Studies of Surrogate Endpoints, Coronary Calcium Progression

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