Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group.

Abstract

on behalf of the CHS Collaborative Research GroupBackground and Purpose: This article describes the prevalence of extracranial carotid atherosclerosis assessed by ultrasonography, its association with risk factors, and its relation to symptomatic coronary disease and stroke in men and women aged >65 years.Methods: Maximum percent stenosis, maximum common carotid artery wall thickness, and maximum internal carotid artery wall thickness were assessed using duplex ultrasound in 5,201 men and women aged >65 years in the Cardiovascular Health Study, a study of the risk factors and natural history of cardiovascular disease in the elderly. Existing coronary disease and stroke were assessed by physical examination and participant history.Results: Detectable carotid stenosis was present in 75% of men and 62% of women, although the prevalence of >50% stenosis was low, 7% in men and 5% in women. Maximum stenosis and maximum wall thickness measurements increased with age and were uniformly greater at all ages in men than in women (p<0.00001). Established risk factors for atherosclerosis (hypertension, smoking, diabetes) and indications of vascular disease (left ventricular hypertrophy, major electrocardiographic abnormality, bruits, and history of heart disease or stroke) related to all three carotid artery measures in the the elderly. Of the three ultrasound measures, the best correlate for a history of coronary disease was maximum internal carotid artery wall thickness. For stroke the best correlate was common carotid artery wall thickness. Multiple logistic regression models of prevalent coronary heart disease and stroke that included the ultrasound findings indicated, after adjustment for age and sex, that maximum internal wall thickness and maximum common carotid wall thickness were significant correlates of both. Maximum stenosis did not add significantly to the correlation.Conclusions: In the elderly the incidence of carotid atherosclerosis was high, although the frequency of severe disease was low. The prevalence and severity of carotid atherosclerosis continued to increase with age even in the late decades of life, and more disease was found in men than in women at all ages. Known risk factors for atherosclerosis continued to relate to carotid abnormalities in the later decades of life, both in symptomatic and asymptomatic subjects.

Prevalence of Carotid Plaque in a 63‐ to 65‐Year‐Old Norwegian Cohort From the General Population: The ACE (Akershus Cardiac Examination) 1950 Study

“…This is supported by a low rate of current smoking, a mean SCORE risk of 3.6%, and a high proportion of diagnosed and treated hypertension at study inclusion. Furthermore, the low prevalence of high‐grade stenosis in our study corresponds with previous studies,4, 15, 16, 27 suggesting a similar rather than a greater atherosclerotic burden. Despite this, our results showed the presence of plaque in 9 of 10 participants.…”

“…Plaque burden increases with age 15, 16, 17. In previous studies, the prevalence of carotid plaques has varied significantly,3, 18, 19, 20, 21, 22, 23, 24 ranging from 25% to 93%.…”

Carotid atherosclerosis in elderly hypertensive patients: potential role of endothelin and plasma antioxidant capacity

“…33 It is also apparent in our study that SBP is an independent factor influencing CCA-IMT in a multivariate analysis. In light of the result obtained from the study by Rodrigo et al, 34 who have recently shown an inverse relationship between SBP and diastolic blood pressure and antioxidants, including FRAP in hypertensive subjects, (in our study, the correlation coefficient between SBP and FRAP ¼ À0.35, P ¼ 0.005; data not shown), it may be postulated that better antioxidant defence also through decreasing blood pressure levels prevents thickening of the arterial wall.…”

Metformin or gliclazide, rather than glibenclamide, attenuate progression of carotid intima-media thickness in subjects with type 2 diabetes

“…Increased intima-media thickness (IMT) of the carotid artery is considered to be an index of the progression of atherosclerosis and a useful predictor of a high-risk group of cardiovascular events [10,11,12,13,14,15]. To evaluate whether the drugs named above have potent anti-atherogenic effects on diabetic patients, we did an open randomised prospective study examining the progression of carotid artery IMT as a surrogate end point.…”