STRATEGIES FOR PREVENTION OF CARDIOVASCULAR EVENTS IN PATIENTS WITH POLYVASCULAR DISEASE



Takanobu Tomaru, M.D., Toho University Sakura Hospital, Japan

Patients with severe carotid arterial sclerosis or those with polyvascular disease (PVD ) are at high risk for cardiovascular events.
Ultrasonography(US) is very useful for detection of PVD and we investigated usefulness of US and prognosis of patients with PVD or those with severe carotid arteriosclerosis. Carotid arterial sclerosis was evaluated by carotid US and plaque score (PS) was calculated. PS was summation of maximum thickness of each plaque and graded as follows: severe (10=PS ), moderate (5=PS <10) and mild (PS<5). Out of 2428 patients who underwent US in 2010, severe arteriosclerosis was observed in 602 patients. 102 of them had PVD. In most of patients with PVD, treatment of diseased major vessels was done. Diagnosis of PVD was based on exercise test, US, coronary angiography. MRI. In 380 patients with severe carotid sclerosis, antiplatelet drug was administered. Most of patients had more than 2 risk factors for arteriosclerosis. During 3 year follow up of patients with severe carotid sclerosis without significant carotid stenosis, cerebral infarction (CI) occurred in 10 (4 with antiplatelet) and acute myocardial infarction (AMI) occurred in 6 (3 with antiplatelet). In 1258 patients with mild carotid arteriosclerosis, CI occurred in 12 and AMI occurred in 7 patients. In 24 cases with severe stenosis, CEA was done and restenosis was not observed. There was no significant difference in development of CI or AMI between severe and mild carotid arteriosclerosis. In 78 cases with PAD, PTA with stenting was done in 32 and restenosis was observed in 5. If severe carotid, coronary or peripheral arterial stenosis is treated, cardiovascular events in patients with PVD can be prevented in most of patients of our hospital. Diagnosis of carotid arterial sclerosis by US and treatment with antiplatelet drug are useful for prevention of cardiovascular event in high risk patients.

Conclusions: In JUPITER, baseline LDL-c was not associated with CVD events, in contrast with significant associations for non-HDL-c and atherogenic particles: apoB and IM-measured non-HDL-p, LDL-p, and select subfractions of VLDL-p and LDL-p. During high-intensity statin therapy, on-treatment levels of LDL-c and atherogenic particles were associated with residual risk of CVD/all-cause death.