, 2025-04-22 07:39:00
Clinical ultrasound is invaluable for detecting atherosclerosis. However, methods to assess vascular areas with atheromatous plaques and their extent remain inconsistent and lack standardisation. To address this, the Spanish Society of Internal Medicine and the Spanish Society of Hypertension and Vascular Risk published two protocols for vascular risk assessment: VAScular UltraSound (VASUS) and VASUS+. The objective of these protocols is to homogenise clinical ultrasound in the assessment of vascular risk in clinical practice.
“Our goal is for all Cardiovascular Risk, Hypertension, and Diabetes Units to adopt these protocols, as they provide a means to detect subclinical disease before it becomes clinically evident,” said Eva María Moya Mateo, internal medicine specialist at Hospital Universitario Infanta Leonor, Madrid, Spain, and lead author of the study, speaking with Univadis Spain, a Medscape Network platform.
Moya Mateo emphasised the growing importance of clinical ultrasound in recent years. For vascular risk, it enables the detection of arterial disease before the appearance of symptoms. “Clinical practice guidelines position the detection of disease before clinical symptoms appear — what we call subclinical disease — as a tool that better stratifies the cardiovascular risk of our patients,” she said.
Identifying Candidates
This diagnostic technique is particularly useful for patients with an intermediate risk of cardiovascular mortality.
“We use risk scales during consultations with patients: Blood pressure levels, cholesterol levels, smoking status. Based on age, we made a 10-year projection of a patient’s risk of developing cardiovascular disease or dying from it. This can indicate moderate, high, or very high risk,” explained Moya Mateo.
For example, a 50-year-old man with some risk factors, she continued, “may be starting to develop hypertension and elevated cholesterol levels. In such cases, lifestyle and dietary measures are typically implemented, followed by monitoring. However, if the cardiovascular risk calculation shows moderate risk, clinical ultrasonography should be used to assess the condition of the arteries. If we detect atherosclerotic disease in his carotid, femoral, or even abdominal aorta arteries, he becomes a high-risk patient and would likely require more intensive treatment than what would be prescribed solely based on a scale that does not examine his arteries internally.”
The Spanish PESA study, a collaborative initiative between Banco Santander, a global banking institution headquartered in Spain, and the Spanish National Centre for Cardiovascular Research Carlos III, monitored more than 4000 Banco Santander professionals aged between 40 and 54 years for over 10 years to better understand early-stage atherosclerosis. “In this study, the prevalence of subclinical atherosclerosis was 63%, and of these, 85% were at low to moderate risk,” noted Moya Mateo.
Protocol Details
Clinical multivessel ultrasound (VASUS protocol) is an ultrasound technique that evaluates large- and medium-sized arteries to detect atherosclerotic plaques and/or pathologic dilations of the abdominal aorta. It involves imaging of five vascular territories: The two bilateral carotid arteries (right and left), two femoral arteries, and the abdominal aorta.
The VASUS+ protocol extends this approach by incorporating transthoracic echocardiography to assess subclinical structural cardiac abnormalities.
“With multivessel ultrasound, we examine the carotid and femoral arteries with the abdominal aorta, as dilatation in this region is associated with increased cardiovascular risk. In the VASUS+ protocol, echocardiographic evaluation helps determine whether there is organ damage to the heart, specifically looking for hypertensive heart disease and left atrial dilation,” Moya Mateo concluded.
Moya Mateo declared no conflicts of interest.
This story was translated from Univadis Spain using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
