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New Point-of-Care Methods to Measure Coronary and Cerebrovascular Risk

practical to screen every patient by directly assessing the arteries. Direct assays such as carotid ultrasound, coronary angiography, computed tomography angiography (CTA), and magnetic resonance angiography (MRA) are usually reserved for patients believed to have significant disease. Some of these techniques are invasive, many are expensive, and all are labor-intensive.

A new method, CIMT uses ultrasound to measure the combined thickness of the intimal and medial layers of the carotid artery walls. OLeary and coworkers (New Engl. J. Med. 1999;340:14-22) tested CIMT in a sample of adults with no prior history of atherosclerotic complications and then followed them for a mean of 6 years. Compared to those in the lowest CIMT quintile, patients in the highest quintile had almost a 4-fold risk of myocardial infarction and stroke. This risk was similar even when statistical analysis controlled for the vascular risk factors mentioned above. In a complementary study, Raitakari and coworkers (JAMA. 2003;290:2277-228) followed adolescents 12-18 years old and found that conventional atherosclerotic risk factors predicted elevated CIMT as adults.

Another new and non-invasive modality is BART, which measures flow-dependent vasodilation in an arm artery Like CIMT, BART has demonstrated usefulness for prospective risk stratification of coronary artery disease (Schroeder S et al. Am Heart J. 1999;138:731-9). Both CIMT and BART have yet to enter routine use, but with their wider availability more patients may be screened. Both techniques require special ultrasound equipment and an experienced operator.

Amidst the new non-invasive methods, the PREVU(x) skin sterol tests holds special promise for Point-of-Care use. The concept behind this test is that cholesterol slowly accumulates in skin tissue, paralleling the buildup of cholesterol on arterial walls. The test provides an independent predictor of coronary artery disease. It has been shown to
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