Screening for asymptomatic cardiovascular disease with noninvasive imaging in patients at high-risk and low-risk according to the European Guidelines on Cardiovascular Disease Prevention: The SMART study

Objective: To assess the prevalence of atherosclerotic risk factors and to investigate the added value of noninvasive imaging in detecting asymptomatic cardiovascular diseases in patients at low risk and high risk according to the European Guidelines on Cardiovascular Disease Prevention. Methods: In the vascular screening program of the University Medical Center Utrecht, patients aged 18 to 79 years who had recently received a diagnosis of manifest vascular disease (coronary heart disease, cerebrovascular disease, abdominal aortic aneurysm, or peripheral arterial disease [PAD]) or had a risk factor (hypertension, hyperlipidemia, or diabetes mellitus) were assessed for atherosclerotic risk factors and (other) arterial diseases by noninvasive means. The European guidelines were applied to quantify the number of high-risk patients. Results: Eighty-eight percent of 3950 patients were considered to be at high-risk. More than 80% had hyperlipidemia, approximately 50% had hypertension, 21% had diabetes mellitus, and 31% were current smokers. An asymptomatic reduced ankle-brachial index (<= 0.90) was most frequently observed in patients with cerebrovascular disease (21%); an asymptomatic abdominal aortic aneurysm ( >= 3.0 cm) in patients with PAD (5%) or cerebrovascular disease (5%); and an asymptomatic carotid stenosis (>= 50%) in patients with PAD (15%). On the basis of noninvasive measurements, 73 (13%) of 545 patients initially considered as low risk were reclassified as high risk. Conclusions. This study confirmed a high prevalence and clustering of modifiable atherosclerotic risk factors in high-risk patients. The yield of noninvasive vascular measurements was relatively low but identified a sizable number of high-risk patients. Standard screening for asymptomatic atherosclerotic disease identified a limited number of vascular abnormalities that necessitated immediate medical attention in patients already identified as high-risk patients.