Wednesday, August 02, 2006

Non-Invasive Assesment of Early Atherothrombosis

The latest European Heart Journal carried the result of AGATHA (a Global Atherothrombosis Assessment), a study of 8891 patients (some of whom are Malaysians) who underwent non-invasive assessment with the Ankle-Brachial index (ABI), as a sign of early atherothrombosis.

The ABI is a comparison of the systolic BP of the Brachial artery and the Posterior Tibialis artery using the BP cuff and doppler ultrasound detection of the systolic BP accurately. The lower the ABI the more the atherothrombosis.

It was interesting to note that 30% of those without clinical atherothrombosis (but with 2 or more coronary risk factors) had a ABI < 0.9. Whereas 40% or more of those with clinical atherothrombosis, had a low ABI. This gives us a simple way to detect early atherothrombosis. To simplify it further, it has now become easier to detect atherosclerosis, with the use of the ABI.

JnJ has now available a small portable machine to allow us to measure ABI in our clinic or community, so that we can diagnose early atherosclerosis, without the need of expensive X-ray scans. Obviously there are no seductive pictures with the ABI machine, and so it may not sell so well, but certainly, the clinical correlation is just as good and it certainly has no dangers. It is like taking a cuff BP. A good history of coronary risk factors (the presence of 2 or more CRF) and the low ABI, will make the presence of atherosclerosis very likely and so makes the use of the CVS prophylactic "polypill" more likely and helpful.

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