Asymptomatic bruit, carotid and vertebrobasilar transient ischemic attacks--a clinical and ultrasonic correlation.

The prevalence of carotid and lower extremity arterial disease was assessed in a healthy population of 56 elderly adults with isolated systolic hypertension. Duplex scans were performed to determine the extent of carotid disease, and postexercise ratios of ankle to arm systolic blood pressure were measured to assess lower extremity arterial disease. Internal carotid stenosis was found in 38% (21 of 56) of subjects and lower extremity arterial disease in 42% (23 of 55). The strongest predictor of internal carotid stenosis was lower extremity arterial disease. Independent risk factors for lower extremity arterial disease were smoking, internal carotid stenosis, and age. A measure of extent of carotid plaque was found to correlate with age, carotid stenosis, male sex, history of smoking, and total cholesterol. The high prevalence of peripheral vascular disease in this population may be related to their age and blood pressure. The high correlation between carotid stenosis and lower extremity arterial disease suggests that persons with peripheral vascular disease should be assessed and treated for atherosclerotic disease in general. (Stroke 1987;18:817-822) M uch of the epidemiology of carotid and lower extremity arterial disease (LEAD) is unknown, largely due to a lack of available data regarding asymptomatic disease. Although noninvasive diagnostic techniques have been used in studying clinical populations, most studies of the general population have been confined to establishing the incidence and prevalence of clinical signs and symptoms. Although asymptomatic disease is not always of clinical interest, it is vital in describing the natural history of a disease and in relating the disease to its risk factors. With the development and improvement of noninvasive vascular diagnostic techniques, the assessment of minimal to moderate disease is now possible. This study is among the few to use noninvasive testing to evaluate the prevalence of arterial disease in a healthy population. Subjects and Methods PopulationThe 56 persons evaluated in the present study were chosen at random from the 109 participants enrolled in the pilot phase of the Systolic Hypertension in the Received December 4, 1986; accepted April 23, 1987. Elderly Program at the University of Pittsburgh, a multicenter clinical trial undertaken to determine the efficacy and possible risks of treating isolated systolic hypertension in the population over age 60. Screening for the study took place at shopping malls, retirement centers, churches, and other locations where predominantly healthy elderly adults could be found. Qualifications for entry into the study included an age > 6 0 , systolic blood pressure >160, and diastolic blood pressure < 9 0 mm Hg. Those with symptomatic bruit were excluded, as well as those with far advanced LEAD (e.g., requiring amputation). Other medical exclusions have been previously reported.1 Diagnostic Methods LEAD was evaluated using postexercise ratios of ankle to arm systolic blood pressure, commonly called the ankle/arm...

Section: -6 7-9 10-12 >12contrasting

confidence: 69%

Section: -6 7-9 10-12 >12mentioning

confidence: 99%

Carotid and lower extremity arterial disease in elderly adults with isolated systolic hypertension.

Sutton¹,

Wolfson²,

Kuller³

1987

“…However, 41% of the patients without bruits also had carotid atherosclerosis. Lo et al 14 reported a similar incidence of carotid lesions in asymptomatic patients with bruits. For detecting early carotid atherosclerosis, cervical bruits appear to be an insensitive marker.…”

Section: Resultsmentioning

confidence: 79%

Ultrasonic evaluation of early carotid atherosclerosis.

Handa

Matsumoto

Maeda

et al. 1990

390

237

We investigated the prevalence of carotid atherosclerosis, including mild early lesions, and its association with cervical bruits and various risk factors (age, male sex, hypertension, hyperlipidemia, diabetes mellitus, obesity, and cigarette smoking) in 232 consecutive Japanese patients. High-resolution real-time B-mode ultrasonography was performed to determine the extent of atherosclerosis, and it was quantified by using a scoring system. The prevalence of carotid atherosclerosis was 49%, 59%, and 41% in all 232 patients, the 100 symptomatic patients, and the 132 asymptomatic patients, respectively. Although carotid lesions were detected frequently (87%) in the 30 patients with cervical bruits, bruits were noted in only 30% of the 88 examined patients with carotid atherosclerosis. Independent risk factors for carotid atherosclerosis in these patients were found to be age, male sex, and hyperlipidemia; diabetes mellitus was a possible risk factor for carotid atherosclerosis. Our study did not show a close association between hypertension and carotid atherosclerosis, and this might be caused by the high prevalence of hypertension in our patients. Our findings suggest an increasing prevalence of carotid atherosclerosis in the Japanese, though this should be confirmed in a populationbased study. Our study demonstrates the clinical usefulness of high-resolution B-mode ultrasonography for the evaluation of early carotid atherosclerosis. (Stroke 1990;21:1567-1572)

“…Before the introduction of noninvasive imaging methods it was impossible to use a control group that was both asymptomatic and demonstrabry free of atherosclerosis because only patients with symptoms underwent angiography. This situation produced, in general, two kinds of studies: those with symptom-free controls who did not undergo angiography and were therefore not necessarily free of disease 30 " 33 - 37 and those with angiogramnegative controls who were not necessarily symptomfree. 34 - 35 In an effort to assure the symptom-free status of controls in the former studies, many investigators eliminated patients with coronary as well as cerebrovascular symptoms from the control group.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, compared with age-and sex-matched controls, Lo et al 37 found plasma concentrations of total cholesterol to be significantly higher in cerebrovascular disease patients with confirmed carotid atheroma.…”

Section: Case-control Studiesmentioning

confidence: 95%

Relation between blood lipids, lipoproteins, and cerebrovascular atherosclerosis. A review.

Tell

Crouse

Furberg

1988

110

Epidemiologic studies have failed to demonstrate a consistent association between blood lipid concentrations and lipoprotein abnormalities and clinical manifestations, for example, cerebral infarction. If lipids do relate to atherosclerosis, then a possible explanation for this apparent contradiction is that risk factors for symptomatic cerebrovascular disease may not necessarily be the same as those for atherosclerosis in general, that is, the factors associated with the precipitation of the clinical event may differ from those related to the underlying process of atherosclerosis. 3Because lipids are often sampled following stroke, relations, or the lack of such, between blood lipids and stroke manifestations cannot automatically be extrap-