Impact of grant-funded carotid intima-media thickness ultrasound on cardiovascular risk assessment and management in an underserved population

Background/Synopsis

Carotid intima-media thickness (CIMT) ultrasound is a well-validated, safe, and inexpensive imaging technique used to assess for atherosclerosis and plaque. This tool has been shown to independently predict future cardiovascular events and improve risk stratification alongside traditional risk factors. However, the impact of CIMT on clinical decision-making in primary prevention remains unclear. Many third-party payors still consider this tool experimental and do not cover the cost of testing. This restricted access leads to suboptimal risk assessment and management, particularly in economically disadvantaged populations.

Objective/Purpose

Identify what proportion of economically underprivileged patients have a change in cardiovascular risk management following CIMT testing.

Methods

A single-center retrospective study was conducted over two years at a Preventive Cardiology clinic. All consecutive patients without known cardiovascular disease who were offered CIMT testing but initially deferred due to cost were enrolled in a grant-funded study. High-risk features on CIMT ultrasound were defined as an intima-media thickness (IMT) ≥ 75th percentile or the presence of plaque. Pre- and post- CIMT data were collected, including lipid profiles, advanced lipid biomarkers, and lipid-lowering therapy (LLT) regimens. Lipid-lowering therapy included statins, ezetimibe, PCSK9 inhibitors, bempedoic acid, and icosapent ethyl.

Results

A total of 51 patients were evaluated (median age 40 years; 73% Female; 61% White, 25% Black, 14% Other). Among them, 54.9% had a high-risk CIMT feature. A change in LLT was observed in 53.6% of patients with high-risk features, which corresponded to a 32.1% initiation and a 21.4% intensification in their prescriptions. High-risk patients experienced a 25.0% increase in statin prescriptions and 21.4% increase in non-statin prescriptions after CIMT ultrasound. Lastly, patients with high-risk features had higher rates of statin prescriptions (82.1% vs. 39.1%) and non-statin prescriptions (57.1% vs. 21.7%) compared to those without high-risk features.

Conclusions

Carotid intima-media thickness ultrasound identified high-risk features in more than half of the patient population, underscoring the residual cardiovascular risk in these individuals. We observed that CIMT ultrasound prompted a change in LLT for 53.6% of patients with high-risk features. This change resulted in a 25.0% increase in statin prescriptions and a 21.4% increase in non-statin prescriptions. Patients with high-risk features were three times as likely to undergo a change in LLT and two times as likely to be prescribed a statin or non-statin medication than those without high-risk features. These findings emphasize the public health impact of CIMT ultrasound in this population. Removing financial barriers to accessing this tool is essential for optimizing preventive cardiovascular care.