cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2012-2-76-84cardiovascular-1778Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMДиагностика субклинического атеросклероза как элемент современной стратегии стратификации сердечнососудистого рискаSubclinical atherosclerosis diagnostics as a component of a modern strategy for cardiovascular risk stratificationКатамадзеН. О.KatamadzeN. O.na.katamadze@mail.ruБерштейнЛ. Л.BersteinL. L.na.katamadze@mail.ruГришкинЮ. Н.GrishkinYu. N.na.katamadze@mail.ruГОУ ДПО Санкт-Петербургская медицинская академия последипломного образования Росздрава, Санкт-ПетербургSt. Petersburg Medical Academy of Post-Diploma Education, St. Petersburg2012200420121127684Copyright © Катамадзе Н.О., Берштейн Л.Л., Гришкин Ю.Н., 20122012Катамадзе Н.О., Берштейн Л.Л., Гришкин Ю.Н.Katamadze N.O., Berstein L.L., Grishkin Y.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1778

Стратификация сердечно-сосудистого риска (ССР) играет важную роль в первичной профилактике атеросклероза и связанных с ним заболеваний. Общепринятые системы расчета ССР (Фремингамская шкала риска, шкала SCORE и др.), предполагающие оценку ограниченного количества традиционных факторов риска (ФР), не дают возможности с высокой точностью рассчитывать индивидуальный риск и осуществлять эффективные профилактические мероприятия. Одним из способов оптимизации оценки ССР является диагностика субклинического атеросклероза, основанная на прямой визуализации преклинических атеросклеротических изменений в стенках артерий. Ультразвуковое исследование (УЗИ) экстракраниальных сегментов сонных артерий (СА) с оценкой толщины комплекса интима-медиа (ТКИМ) и атеросклеротических бляшек (АБ) является важным методом такой диагностики. В обзоре обсуждаются патогенетические механизмы утолщения КИМ, стандарты УЗ оценки ТКИМ и интерпретации полученных результатов, их значимость для оптимизации расчета ССР.

Cardiovascular risk (CVR) stratification plays an important role in the primary prevention of atherosclerosis and associated disorders. The standard scales for CVR assessment (Framingham scale, SCORE scale, etc.) are focused on a limited number of traditional risk factors (RFs) and, therefore, neither produce precise individual risk estimates, nor increase the effectiveness of preventive interventions. One of the methods for CVR assessment optimisation is the diagnostics of subclinical atherosclerosis, based on the direct visualisation of preclinical atherosclerotic changes in arterial wall. Extracranial carotid artery (CA) ultrasound and assessment of the intima-media thickness (IMT) index or atherosclerotic plaque volume (PV) is an important method of the preclinical atherosclerosis diagnostics. The review discusses pathogenetic mechanisms of IMT increase, the standards of ultrasound IMT assessment and its interpretation, and the role of the information obtained for optimization of the CVR evaluation.

стратификация сердечно-сосудистого рискасубклинический атеросклерозсонные артериитолщина комплекса интима-медиаатеросклеротическая бляшкаcardiovascular risk stratificationsubclinical atherosclerosiscarotid arteriesintima-media thicknessatherosclerotic plaqueReferencesWorldhealthorganization. Cardiovasculardiseases. Fact sheet 2011; №317. http://www.who.int/mediacentre/factsheets/fs317/en/index.htmlWorldhealthorganization. Cardiovasculardiseases. Fact sheet 2011; №317. http://www.who.int/mediacentre/factsheets/fs317/en/index.htmlWorldHealthOrganization. PreventionofCardiovascularDisease. Guidelines for assessment and managementofcardiovascularrisk. Geneva 2007.WorldHealthOrganization. PreventionofCardiovascularDisease. Guidelines for assessment and managementofcardiovascularrisk. Geneva 2007.Heart Disease and Stroke Statistics 2008 Update: A Report From the America Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008; 117; e25-146.Heart Disease and Stroke Statistics 2008 Update: A Report From the America Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2008; 117; e25-146.National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-421.National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-421.Ajani UA, Ford ES. Has the risk for coronary heart disease changed among US adults. JACC 2006; 48: 1177-82.Ajani UA, Ford ES. Has the risk for coronary heart disease changed among US adults. JACC 2006; 48: 1177-82.Akosah KO, Schaper A, Cogbill C, et al. Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? JACC 2003; 41: 1475-9.Akosah KO, Schaper A, Cogbill C, et al. Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? JACC 2003; 41: 1475-9.Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987-1003.Conroy RM, Pyorala K, Fitzgerald AP, et al. Estimation of ten year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987-1003.Korshunov VA, Schwartz SM, Berk BC. Vascular Remodeling: Hemodynamic and Biochemical Mechanisms Underlying Glagov’s Phenomenon. Arterioscler Thromb Vasc Biol 2007; 27: 1722-8.Korshunov VA, Schwartz SM, Berk BC. Vascular Remodeling: Hemodynamic and Biochemical Mechanisms Underlying Glagov’s Phenomenon. Arterioscler Thromb Vasc Biol 2007; 27: 1722-8.2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. JACC 2010; 56: 50-103.2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. JACC 2010; 56: 50-103.White-Willson medical center. Cardiac imaging groupe and preventive cardiology. Coronary artery calcium scoring. Info Booklet 2004.White-Willson medical center. Cardiac imaging groupe and preventive cardiology. Coronary artery calcium scoring. Info Booklet 2004.Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. JACC 1990; 15: 827-32.Agatston AS, Janowitz WR, Hildner FJ, et al. Quantification of coronary artery calcium using ultrafast computed tomography. JACC 1990; 15: 827-32.Schmermund A, Erbel R. Unstable coronary plaque and its relation to coronary calcium. Circulation 2001; 104: 1682-7.Schmermund A, Erbel R. Unstable coronary plaque and its relation to coronary calcium. Circulation 2001; 104: 1682-7.Smith SC, Greenland P, Grundy SM. Prevention conference V: beyond secondary prevention: Identifying the high-risk patient for primary prevention: Executive summary. Circulation 2000; 101: 111-6.Smith SC, Greenland P, Grundy SM. Prevention conference V: beyond secondary prevention: Identifying the high-risk patient for primary prevention: Executive summary. Circulation 2000; 101: 111-6.Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 74: 1399-406.Pignoli P, Tremoli E, Poli A, et al. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 74: 1399-406.Leljuk V.G., Leljuk S.Je. Ultrasound angiology. Moscow: Real’noe vremja 2003; 92-3. Russian (Лелюк В.Г., Лелюк С.Э. Ультразвуковая ангиология. Москва: Реальное время 2003; 92-3).Leljuk V.G., Leljuk S.Je. Ultrasound angiology. Moscow: Real’noe vremja 2003; 92-3. Russian (Лелюк В.Г., Лелюк С.Э. Ультразвуковая ангиология. Москва: Реальное время 2003; 92-3).Klimov A.N., Shljahto E.V. Atherosclerosis. Problems of pathogenesis and therapy. Saint-Petersburg: Medicinskaja literatura 2006; 10-11. Russian (Климов А.Н., Шляхто Е.В. Атеросклероз. Проблемы патогенеза и терапии. Санкт-Петербург: Медицинская литература 2006; 10-11).Klimov A.N., Shljahto E.V. Atherosclerosis. Problems of pathogenesis and therapy. Saint-Petersburg: Medicinskaja literatura 2006; 10-11. Russian (Климов А.Н., Шляхто Е.В. Атеросклероз. Проблемы патогенеза и терапии. Санкт-Петербург: Медицинская литература 2006; 10-11).Chambless LE, Heiss G, Folsom AR, et al. Associationofcoronaryheart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. AmJEpidemiol 1997; 146(6): 394-483.Chambless LE, Heiss G, Folsom AR, et al. Associationofcoronaryheart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. AmJEpidemiol 1997; 146(6): 394-483.Dyslipidemia diagnostics and correction in atherosclerosis prevention and treatment. Nationalguidelines (4th review). Cardiovasculartreatmentandprevention 2009; 8(6): (Annex 3): 15-6. Russian (Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации (IV пересмотр). Кардиоваскулярная терапия и профилактика 2009; 8(6): (Приложение 3): 15-6).Dyslipidemia diagnostics and correction in atherosclerosis prevention and treatment. Nationalguidelines (4th review). Cardiovasculartreatmentandprevention 2009; 8(6): (Annex 3): 15-6. Russian (Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации (IV пересмотр). Кардиоваскулярная терапия и профилактика 2009; 8(6): (Приложение 3): 15-6).Howard G, Sharrett AR, Heiss G, et al. Carotid artery intimal-medial thickness distribution in general populations as evaluatedby B-mode ultra-sound. ARIC Investigators. Stroke 1993; 24: 1297-304.Howard G, Sharrett AR, Heiss G, et al. Carotid artery intimal-medial thickness distribution in general populations as evaluatedby B-mode ultra-sound. ARIC Investigators. Stroke 1993; 24: 1297-304.Finn AV, Kolodgie FD, Virmani R. Correlation between carotid intimal/ medial thickness and atherosclerosis: A point of view from pathology. Arterioscler Thromb Vasc Biol 2010; 30: 177-81.Finn AV, Kolodgie FD, Virmani R. Correlation between carotid intimal/ medial thickness and atherosclerosis: A point of view from pathology. Arterioscler Thromb Vasc Biol 2010; 30: 177-81.Espeland MA, Tang R, Terry JG, et al. Associations of risk factors with segment-specific intimal-medial thickness of the extracranial carotid artery. Stroke 1999; 30: 1047-55.Espeland MA, Tang R, Terry JG, et al. Associations of risk factors with segment-specific intimal-medial thickness of the extracranial carotid artery. Stroke 1999; 30: 1047-55.Jurcut C, Jurcut R et al. Cardiovascular risk and rheumatoid arthritis: from mechanisms of atherosclerosis to therapeutic approach.Rom J Intern Med 2004; 42(4): 659-69.Jurcut C, Jurcut R et al. Cardiovascular risk and rheumatoid arthritis: from mechanisms of atherosclerosis to therapeutic approach.Rom J Intern Med 2004; 42(4): 659-69.Gasparyan AY. The use of carotid artery ultrasonography in different clinical conditions. Open Cardiovasc Med J 2009; 3: 78-80.Gasparyan AY. The use of carotid artery ultrasonography in different clinical conditions. Open Cardiovasc Med J 2009; 3: 78-80.Kuller LH, Velentgas P, Barzilay J, et al. Diabetes mellitus: subclinical cardiovascular disease and risk of incident cardiovascular disease and all cause mortality. Arterioscler Thromb Vasc Biol 2000; 20: 823-9.Kuller LH, Velentgas P, Barzilay J, et al. Diabetes mellitus: subclinical cardiovascular disease and risk of incident cardiovascular disease and all cause mortality. Arterioscler Thromb Vasc Biol 2000; 20: 823-9.Veldhuijzen van Zanten JJ, Kitas GD. Inflammation, carotid intima-media thickness and atherosclerosis in rheumatoid arthritis. Arthritis Res Ther 2008; 10: 102.Veldhuijzen van Zanten JJ, Kitas GD. Inflammation, carotid intima-media thickness and atherosclerosis in rheumatoid arthritis. Arthritis Res Ther 2008; 10: 102.O’Leary DH, Polak JF, Kronmal RA, et al. Carotid artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999; 340(1): 14-22.O’Leary DH, Polak JF, Kronmal RA, et al. Carotid artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999; 340(1): 14-22.Everson SA, Kaplan GA, Goldberg DE, et al. Hopelessness and 4-year regression of carotid atherosclerosis the Kuopio Ischemic Heart Disease Risk Factor Study.Arterioscler Thromb Vasc Biol 1997; 17: 1490-5.Everson SA, Kaplan GA, Goldberg DE, et al. Hopelessness and 4-year regression of carotid atherosclerosis the Kuopio Ischemic Heart Disease Risk Factor Study.Arterioscler Thromb Vasc Biol 1997; 17: 1490-5.Li C, Engstrom G, Berglund G, et al. Incidence of ischemic stroke in relation to asymptomatic carotid artery atherosclerosis in subjects with normal blood pressure. A prospective cohort study. Cerebrovasc Dis 2008; 26(3): 297-303.Li C, Engstrom G, Berglund G, et al. Incidence of ischemic stroke in relation to asymptomatic carotid artery atherosclerosis in subjects with normal blood pressure. A prospective cohort study. Cerebrovasc Dis 2008; 26(3): 297-303.Lorenz MW, Markus HS, Bots ML, et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115: 459-67.Lorenz MW, Markus HS, Bots ML, et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115: 459-67.Sehestedt T, Jeppesen J, Hansen TW, et al. Risk prediction in improved by adding markers of subclinical organ damage to SCORE. Eur Heart J 2010; 31: 883-91.Sehestedt T, Jeppesen J, Hansen TW, et al. Risk prediction in improved by adding markers of subclinical organ damage to SCORE. Eur Heart J 2010; 31: 883-91.Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim intima-media thickness consensus. Cerebrovasc Dis 2004; 18(4): 346-9.Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim intima-media thickness consensus. Cerebrovasc Dis 2004; 18(4): 346-9.Li R, Duncan BB, Metcalf PA, et al. B-mode-detected carotid artery plaque in a general population. Atherosclerosis Risk in Communities (ARIC) Study Investigators. Stroke 1994; 25: 2377-83.Li R, Duncan BB, Metcalf PA, et al. B-mode-detected carotid artery plaque in a general population. Atherosclerosis Risk in Communities (ARIC) Study Investigators. Stroke 1994; 25: 2377-83.Wattanakit K, Folsom AR, Chambless LE, et al. Risk factors for cardiovascular event recurrence in the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J 2005; 149: 606-12.Wattanakit K, Folsom AR, Chambless LE, et al. Risk factors for cardiovascular event recurrence in the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J 2005; 149: 606-12.Spence JD, Eliasziw M, DiCicco M, et al. Carotid plaque area. A tool for targeting and evaluating vascular preventive therapy. Stroke 2002; 33: 2916-22.Spence JD, Eliasziw M, DiCicco M, et al. Carotid plaque area. A tool for targeting and evaluating vascular preventive therapy. Stroke 2002; 33: 2916-22.Rundek T, Arif H, Boden-Albala B, et al. Sacco Carotid plaque, a subclinical precursor of vascular events: The Northern Manhattan Stud. Neurology 2008; 70(14): 1200-7.Rundek T, Arif H, Boden-Albala B, et al. Sacco Carotid plaque, a subclinical precursor of vascular events: The Northern Manhattan Stud. Neurology 2008; 70(14): 1200-7.Johnson JM, Kennely M, Decesale D, et al. Natural history of asymptomatic plaque. Arch Surg 1985; 120: 1010-2.Johnson JM, Kennely M, Decesale D, et al. Natural history of asymptomatic plaque. Arch Surg 1985; 120: 1010-2.Ellisiv B, Mathiesen EB, Kaare H, et al. Echolucent plaques are associated with high risk of ischemic cerebrovascular events in carotid stenosis. Circulation 2001; 103: 2171-5.Ellisiv B, Mathiesen EB, Kaare H, et al. Echolucent plaques are associated with high risk of ischemic cerebrovascular events in carotid stenosis. Circulation 2001; 103: 2171-5.Lester SJ, Eleid MF. Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis. Mayo Clin Proc 2009; 84(3): 229-33.Lester SJ, Eleid MF. Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis. Mayo Clin Proc 2009; 84(3): 229-33.Bots ML, Baldassarre D, Simon A, et al. Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations? Eur Heart J 2007; 28(4): 398-406.Bots ML, Baldassarre D, Simon A, et al. Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations? Eur Heart J 2007; 28(4): 398-406.Amato M, Montorsi P, Ravani A, et al. Carotid intima-media thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultra-sound findings. Eur Heart J2007; 28(17): 2094-101.Amato M, Montorsi P, Ravani A, et al. Carotid intima-media thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultra-sound findings. Eur Heart J2007; 28(17): 2094-101.Stein JH, Pamela S. Douglas, et al. Distribution and cross-sectional age-related increases of carotid artery intima-media thickness in young adults: The Bogalusa Heart Study. Stroke 2004; 35: 2782-7.Stein JH, Pamela S. Douglas, et al. Distribution and cross-sectional age-related increases of carotid artery intima-media thickness in young adults: The Bogalusa Heart Study. Stroke 2004; 35: 2782-7.Stein JH, Fraizer MC, Aeschlimann SE, et al. Vascular age: integrating carotid intima-media thickness measurements with global coronary risk assessment. Clin Cardiol 2004; 27(7): 388-92.Stein JH, Fraizer MC, Aeschlimann SE, et al. Vascular age: integrating carotid intima-media thickness measurements with global coronary risk assessment. Clin Cardiol 2004; 27(7): 388-92.Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008; 21(2): 93-111.Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008; 21(2): 93-111.Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque to vulnerable patient-Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. AmJCardiol 2006; 98(2A): 2H-15.Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque to vulnerable patient-Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. AmJCardiol 2006; 98(2A): 2H-15.

The authors declare that there are no conflicts of interest present.