Response to Letter by Hadjiev and Mineva
Professor Hadjiev and Dr Mineva have raised the following question: Which patients having asymptomatic carotid artery stenosis (ACAS) might benefit from screening? In our study,1 we reported accurate prevalence estimates of moderate and severe ACAS in the general population. We fully agree that these data might be helpful for further studies of cost-effectiveness of screening the general population for ACAS. Many factors, however, affect the cost-effectiveness of screening in an asymptomatic population.
In their commentary, Hadjiev and Mineva call for additional studies to help to clarify geographic and race–ethnic differences in the distribution patterns of vascular risk factors related to ACAS.2 We suggest that careful decision modeling, followed by other targeted studies only as needed to clarify key areas of uncertainty, should play a key role in decisions about screening for ACAS in the general population or certain high-risk populations.3 By bringing together information about test performance, treatment efficacy, population-level distributions of disease rates, and competing morbidity and mortality, decision modeling can help provide answers to the question of who should be screened for ACAS.
de Weerd M, Greving JP, Hedblad B, Lorenz MW, Mathiesen EB, O'Leary DH, Rosvall M, Sitzer M, Buskens E, Bots ML. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke. 2010; 41: 1294–1297.
Hadjiev DI, Mineva PP. Which patients having asymptomatic carotid artery stenosis might benefit from screening? Stroke. 2010; 41: e587.