INTRODUCTION: Poor adherence to lipid-lowering therapy remains one of the major challenges in primary cardiovascular prevention, with adherence rates rarely exceeding 50%. Point-of-care ultrasound (POCUS) of the carotid arteries, performed by family medicine physicians, represents a novel approach that may contribute to improving adherence in primary cardiovascular prevention. The presence of carotid atherosclerotic plaques is an important finding that influences treatment initiation decisions and, when visualized directly on the ultrasound screen, provides compelling evidence for both patients and physicians regarding the importance of preventive therapy.
METHODS: We conducted a randomized interventional study involving 379 apparently healthy individuals with cardiovascular risk factors recruited from ten family medicine practices. The primary objective was to assess the effect of a carotid artery POCUS intervention on adherence to lipid-lowering therapy, measured by changes in serum low-density lipoprotein cholesterol levels during a 9-month follow-up period. Additionally, we determined the prevalence of carotid atherosclerotic plaques and evaluated the diagnostic performance of carotid artery POCUS for plaque detection by calculating its sensitivity and specificity. Furthermore, we investigated the influence of carotid plaque presence on the intensity of lipid-lowering therapy prescribed by family medicine physicians.
RESULTS: The prevalence of carotid atherosclerotic plaques among apparently healthy individuals aged 40–69 years with cardiovascular risk factors was 68.9% (95% CI: 63.8–73.6). Carotid artery POCUS demonstrated high sensitivity (96.6%; 95% CI: 91.7–98.8) and specificity (90.0%; 95% CI: 79.5–96.2) for the detection of carotid atherosclerotic plaques. No statistically significant difference in adherence to lipid-lowering therapy was observed between the intervention and control groups (p = 0.20), nor between participants with and without carotid plaques (p = 0.40). However, the presence of carotid plaques had a statistically significant impact on the intensity of lipid-lowering therapy prescribed by family physicians (p < 0.001).
CONCLUSIONS: Carotid artery POCUS is a highly sensitive and specific method for the detection of carotid atherosclerosis. Atherosclerotic plaques were identified in approximately seven out of ten apparently healthy individuals with cardiovascular risk factors. Although visualization of carotid plaques during carotid artery POCUS did not improve adherence to lipid-lowering therapy, it significantly influenced the intensity of treatment prescribed by family physicians.
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