Carotid and femoral bifurcation plaques detected by ultrasound as predictors of cardiovascular events.

Risk factor-based algorithms give a good estimate of cardiovascular (CV) risk at the population level but are often inaccurate at the individual level. Detecting preclinical atherosclerotic plaques in the carotid and common femoral arterial bifurcations by ultrasound is a simple, non-invasive way of detecting atherosclerosis in the individual and thus more accurately estimating his/her risk of future CV events. The presence of plaques in these bifurcations is independently associated with increased risk of CV death and myocardial infarction, even after adjusting for traditional risk factors, while ultrasonographic characteristics of vulnerable plaque are mostly associated with increased risk for ipsilateral ischaemic stroke. The predictive value of carotid and femoral plaques for CV events increases in proportion to plaque burden and especially by plaque progression over time. Assessing the burden of carotid and/or common femoral bifurcation plaques enables reclassification of a significant number of individuals with low risk according risk factor-based algorithms into intermediate or high CV risk and intermediate risk individuals into the low- or high CV risk. Ongoing multimodality imaging studies, supplemented by clinical and genetic data, aided by machine learning/ artificial intelligence analysis are expected to advance our understanding of atherosclerosis progression from the asymptomatic into the symptomatic phase and personalize prevention.