Danno d'organo subclinico in soggetti a basso rischio cardiovascolare

ROLE OF ORGAN DAMAGE MARKERS IN GLOBAL EVALUATION OF CARDIOVASCULAR RISK IN LOW RISK PATIENTS. Objective: Current guidelines for the assessment of cardiovascular risk suggest the use of a global risk score based on traditional risk factors for all asymptomatic adults. Actually these scores don’t consider target organ damage leading to a possible mismatch between individual risk score and the real atherosclerotic burden of a subject. The aim of this study is to assess the prevalence of traditional risk factors and to evaluate the presence of target organ damage, focusing attention on low risk patients. Design and method: We recruited 244 asymptomatic volunteers (168 males and 76 females) aged between 40 and 64, we assessed their traditional risk factors and we calculated the cardiovascular risk score based on the Italian “Progetto Cuore” guidelines. Eventually, we evaluated target organ damage with Carotid Ultrasound, Ankle-Brachial Index, Transthoracic Echocardiography and Electrocardiography. Results: We found a high prevalence of avoidable risk factors. We also noticed remarkably poor awareness of cardiovascular risk in the population, with a high prevalence of undiagnosed conditions (hypertension: 44% of men and 44% of women; hypercholesterolemia: 34% of men and 25% of women). Almost all patients (94% of males and 100% of females) had a cardiovascular risk score <10% (10-year risk of an acute cardiovascular event). Even among these relatively low-risk individuals we found a high prevalence of vascular damage (14% of men and 4% of women had a Intima-media thickness> 0.9 mm, 22% of men and 5% of women had at least a carotid plaque, 4% of men and 5% of women had pathological ankle-brachial index) and starting cardiac remodeling (in 12% of men cardiac septum was >1.1 cm). Conclusions: Our main finding is that even subjects with low cardiovascular risk (according to individual risk score) have a high prevalence of target organ damage, so the research of organ damage could be useful to reclassify cardio-vascular risk in an assessment of a real “individual-based” risk-score.