Imaging Markers of Subclinical Atherosclerosis

Atherosclerosis is a generalized disorder that progresses very slowly. Early detection of atherosclerosis is very important to prevent cardiovascular disease such as myocardial infarction, stroke and sudden cardiac death. Various surrogate markers have recently been proposed for the early detection of atherosclerosis in asymptomatic patients who have one or more risk factors. Among them, biomarkers such as CRP, Interleukin, myeloperoxidase, fibrinogen, homocystein and lipoprotein (a) are established as predictors of atherothrobotic events in apparently healthy individuals. Although these novel biomarkers provide important information into the pathophysiology of atherosclerosis, no clear evidence exist that lowering the plasma level of these markers reduces the vascular risk. Imaging markers such as the carotid intima-media thickness and brachial arterial flow mediated vasodilation as assessed by ultrasound, coronary calcification as assessed by CT, and the pulse wave velocity and augmentation index as assessed by tonometry can visualize the arterial wall and directly measure the arterial function. These imaging markers are very useful clinical tools for detecting the early changes of vascular structure and also for predicting cardiovascular events, in addition to being more precise biomarkers in asymptomatic subjects. (Korean Circulation J 2007;37:1-8)