Risk of Stroke in Asymptomatic Persons with Cervical Arterial Bruits

Abstract

A survey of the rural community in Evans County, Georgia, revealed cervical arterial bruits in 72 (4.4 per cent) of 1620 persons 45 years of age of older without previous stroke, transient ischemic attacks, or overt ischemic heart disease. The prevalence of such asymptomatic bruits increased with age and was greater in women and persons with hypertension. We estimated the risk of stroke associated with cervical bruits during a six-year follow-up period, taking age and blood pressure into account. The presence of asymptomatic bruits was associated with a significantly higher risk of stroke in men but not in women, with odds ratios of 7.5 and 1.6, respectively. Despite the high risk of stroke among men with bruits, the correlation between the location of the bruits and the type of subsequent stroke was poor. Moreover, cervical bruits in men were a risk factor for death from ischemic heart disease. We suggest that asymptomatic cervical bruits are an indication of systemic vascular disease and do not themselves justify invasive diagnostic procedures or surgical correction of underlying extracranial arterial lesions.

The prognostic significance of asymptomatic carotid bruits in the elderly

“…The large numbers of persons aged 70 years and older in SHEP may explain the lack of association of carotid bruits with subsequent stroke in this cohort compared with previous population-based studies. [8][9][10] Our findings are consistent with those of Van Ruiswyk and colleagues, 11 who found that carotid bruits did not predict stroke (RR 1.1; 95% CI 0.45, 2.7) in a cohort of 241 frail nursing home residents aged 75 years or older. However, in addition to providing well-defined cohort and adjudicated end points, our study subjects more closely resemble patients who would be candidates for office screening-they were at increased risk of stroke, but otherwise were in relatively good health, and would have the most to lose from a catastrophic event.…”

“…Also, in one study center, SHEP examiners identified bruits in 8 (7.3%) of 109 participants; whereas a single observer, as a part of an ancillary study, detected 19 bruits in 99 (19.2%) of the members of the same cohort. 23 However, in SHEP the overall prevalence and location of bruits is similar to that in other studies, 9,10 suggesting that, however imprecise, our findings probably apply to the performance of neck auscultation in a typical clinical setting.…”

“…Although persons with carotid bruit were 50% more likely to develop a completed stroke, this relation was confounded by more important stroke risk factors. As in previous studies, 8,9 events were as likely to occur contralateral to the bruit, when the location of the stroke was known. Although in nearly every subgroup persons with bruits were more likely than those without bruits to develop a completed stroke, in none of these categories was the strength of the association statistically significant.…”

“…5 Early studies found an increased risk of carotid bruits among persons suffering stroke compared with control subjects 6,7 ; however, these studies were nonblinded and potentially subject to observer bias. Population-based prospective studies found that persons with carotid bruits were at higher risk of subsequent stroke, [8][9][10] but age-specific risks were not reported. In contrast, a study of nursing home residents aged 75 years or older found no increased risk of stroke among persons with asymptomatic carotid bruits.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…In the general population, asymptomatic carotid bruits do not appear to greatly increase the risk of cerebral vascular disease (770,771). Although asymptomatic carotid bruits increase the risk of stroke after coronary artery bypass surgery, the increase in risk is probably small (772).…”