UTILIDAD DE LA ECOGRAFÍA DE CARÓTIDAS Y FEMORALES EN ATENCIÓN PRIMARIA COMO FACTOR MODIFICADOR DE RIESGO CARDIOVASCULAR EN PACIENTES DISLIPÉMICOS CON UN SCORE DE RIESGO BAJO-MODERADO

Abstract

Objective: To assess the usefulness of carotid and femoral ultrasound in Primary Care to improve cardiovascular risk stratification in dyslipidemic patients with low or moderate SCORE2, and to analyze its association with cardiovascular risk factors.

Design: Observational, cross-sectional, retrospective, and uncontrolled study.

Setting: Two urban Primary Care centers.

Method: From a cohort of dyslipidemic patients, 244 were contacted; 122 met inclusion criteria and 90 were recruited. Inclusion criteria: age ≥40 years (men <60, women <75), low or moderate SCORE2, and adequate metabolic control. Exclusion criteria: previous cardiovascular disease, advanced diabetes, chronic kidney disease ≥G3b, familial hypercholesterolemia, Lp(a) >180 mg/dL, or lack of recent lipid profile.

Carotid and femoral ultrasounds were performed to detect atheromatous plaques. Clinical variables (age, sex, BMI, history), laboratory data (total cholesterol, LDL, HDL, triglycerides, ApoB, Lp(a)) and lifestyle factors were collected. Statistical analysis included normality tests (Kolmogorov-Smirnov), comparison of proportions (chi-square), and means (Student’s t-test or Mann-Whitney U). Significance level: p < 0.05. Software: SPSS v.30 and R.

Results: Atheromatous plaques were found in 31.1% of patients initially classified as low or moderate risk, indicating subclinical atherosclerosis not detected by conventional methods. Non-significant trends were observed toward a higher presence of plaques with older age and elevated triglycerides. High HDL and lipid-lowering therapy were associated with a lower presence of plaques.

Conclusions: Vascular ultrasound in Primary Care allows the detection of subclinical atherosclerosis in patients with low or moderate cardiovascular risk, facilitating their reclassification to high risk. These findings support its incorporation as a complementary tool in cardiovascular risk assessment at this level of care.

Keywords: Atherosclerosis, Doppler ultrasound, cardiovascular prevention, risk factors, primary care.