Abstract
Cardiovascular disease (CVD) continues to be a substantial contributor to morbidity and mortality. CVD is used as an umbrella term for numerous conditions including heart disease, congenital heart defects, stroke, arrhythmia, heart valve problems, heart failure, and peripheral arterial disease. 1 Heart disease alone is the leading cause of death in both men and women in the United States. 2 Patients’ medical conditions and lifestyle choices contribute to their risk for developing CVD. Some of the main risk factors are high blood pressure, increased low-density lipoprotein cholesterol, and smoking. In addition, other key factors include diabetes, obesity, physical inactivity, and excessive alcohol use. 2 Traditionally, patients with CVD or patients at risk for CVD are recommended to manage their risk factors, by methods such as monitoring blood pressure, cholesterol, and hemoglobin A1C. Physicians also recommend that patients try to reduce sodium, control their weight, maintain physical activity, manage their stress, and not smoke. 3 Physicians customarily try to evaluate a patient’s probability for CVD through the traditional risk factors listed above. It is expected that patients who meet all of these factors will likely be at an increased risk of CVD and possibly other comorbidities. However, what is a patient’s risk who has one or more risk factors? How does a family history of CVD affect risk? What is a patient’s level of CVD risk? Can CVD risk be categorized as moderate or highly elevated?
As sonographers and vascular technologists, we consider CVD risk to be measured by very traditional CVD indicators such as carotid intima thickness, coronary calcium, blood pressure, atherosclerosis, and the Framingham risk score. Previous research has found that sonographic measures of plaque can independently predict cardiovascular events. 4 When these measures were added to Framingham risk scores, the ability to predict CVD risk and events significantly improved. 4 Interestingly, researchers have found that because of the complexity of CVD, other markers may improve the detection of a patient’s risk for disease. 5 Recent research has shown that the gut microbiota or microbiome has a strong relationship to the development of CVD. 5 Gut microbiome is the term given to bacteria, archaea, and viruses that live within the gut. 6 Gut bacteria are quite diverse compared with other microbiomes throughout the body and are essential for digestion and nutrition. 6 The link between CVD and the gut microbiome has gained much interest as a pathway to ascertain CVD risk, offer diagnostic information, and provide therapy for disease. 6
Additional research has explored the relationship between gut microbiota and early signs of vascular changes in patients without clinical CVD. 7 Sonography to measure carotid intimal thickness was used to assess changes in the arterial wall. Results showed early arterial wall changes related with higher pathogens in the gut microbiome, even in apparently healthy participants. 7
Still, there is a need to improve CVD risk assessment. Many CVD events have occurred in patients who were considered to be in the low- or intermediate-risk categories. Therefore, an accurate and cost-effective method to better quantify CVD risk is needed. Sonography has tremendous potential to be used in conjunction with other biomarkers to better determine CVD risk in patients who would benefit from earlier therapies and treatments. Sonographic estimation of plaque and cardiovascular assessment combined with gut biome and other markers of CVD may provide a better assessment of a patient’s CVD risk. Given the increasing health care burden attributed to CVD, would suggest that sonography could play a vital role in risk assessment. This is a call for more research to determine the interplay between sonography and associated biomarkers to better estimate CVD risk.