Carotid Intima-Media Thickness: Can It Close the 'Detection Gap' for Cardiovascular Risk?

Given the high morbidity and mortality and the large societal burden imposed by cardiovascular (CV) disease, there have been many strong interdisciplinary efforts to identify at-risk patients during the past decades. The Framingham study and other population-based studies of CV risk, outcomes, and the effect of therapeutic interventions on both have identified what are now considered the “traditional” modifiable CV risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, smoking, obesity, and sedentary lifestyle. However, approximately one-third of CV events are not readily attributed to these traditional CV risk factors.1,2 This finding, often called the detection gap, suggests that other nontraditional or “novel” conditions may cause or contribute to CV disease. At the same time, the trend toward lower definition thresholds for traditional CV risk factors (eg, the change in criteria for what constitutes “low” protective high-density lipoprotein levels, from previously less than 0.91 mmol/L (