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Stroke, Vol 23, 1752-1760, Copyright © 1992 by American Heart Association
DH O'Leary, JF Polak, RA Kronmal, SJ Kittner, MG Bond, SK Wolfson Jr, W Bommer, TR Price, JM Gardin and PJ Savage
BACKGROUND 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 > or = 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 > or = 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 > or = 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 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.
ARTICLES
Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. The CHS Collaborative Research Group
Division of Radiology, Geisinger Medical Center, Danville, Pa.
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 G. Zuliani, A. Cherubini, S. Volpato, E. Palmieri, P. Mecocci, P. De Rango, P. Cao, F. Costantini, A. Mezzetti, F. Mascoli, et al. Genetic Factors Associated With the Absence of Atherosclerosis in Octogenarians J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2002; 57(9): M611 - 615. [Abstract] [Full Text] [PDF]
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L. A. Lange, D. W. Bowden, C. D. Langefeld, L. E. Wagenknecht, J. J. Carr, S. S. Rich, W. A. Riley, and B. I. Freedman Heritability of Carotid Artery Intima-Medial Thickness in Type 2 Diabetes Stroke, July 1, 2002; 33(7): 1876 - 1881. [Abstract] [Full Text] [PDF]
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R. F. Redberg, P. Greenland, V. Fuster, K. Pyorala, S. N. Blair, A. R. Folsom, A. B. Newman, D. H. O'Leary, T. J. Orchard, B. Psaty, et al. Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group III: Risk Assessment in Persons With Diabetes Circulation, May 7, 2002; 105 (18): e144 - e152. [Full Text] [PDF]
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A. H. Xiang, S. P. Azen, T. A. Buchanan, L. J. Raffel, S. Tan, L.S.-C. Cheng, J. Diaz, E. Toscano, M. Quinonnes, C.R. Liu, et al. Heritability of Subclinical Atherosclerosis in Latino Families Ascertained Through a Hypertensive Parent Arterioscler Thromb Vasc Biol, May 1, 2002; 22(5): 843 - 848. [Abstract] [Full Text] [PDF]
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 P R J Ames, A Margarita, J D. Alves, C Tommasino, L Iannaccone, and V Brancaccio Anticardiolipin antibody titre and plasma homocysteine level independently predict intima media thickness of carotid arteries in subjects with idiopathic antiphospholipid antibodies Lupus, April 1, 2002; 11(4): 208 - 214. [Abstract] [PDF]
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L.M. Cupini, P. Pasqualetti, M. Diomedi, F. Vernieri, M. Silvestrini, B. Rizzato, F. Ferrante, and G. Bernardi Carotid Artery Intima-Media Thickness and Lacunar Versus Nonlacunar Infarcts Stroke, March 1, 2002; 33(3): 689 - 694. [Abstract] [Full Text] [PDF]
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J.Y. Streifler, N. Rosenberg, A. Chetrit, R. Eskaraev, B.A. Sela, R. Dardik, A. Zivelin, B. Ravid, J. Davidson, U. Seligsohn, et al. Cerebrovascular Events in Patients With Significant Stenosis of the Carotid Artery Are Associated With Hyperhomocysteinemia and Platelet Antigen-1 (Leu33Pro) Polymorphism Stroke, December 1, 2001; 32(12): 2753 - 2758. [Abstract] [Full Text] [PDF]
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 F. A. BENEDETTO, F. MALLAMACI, G. TRIPEPI, and C. ZOCCALI Prognostic Value of Ultrasonographic Measurement of Carotid Intima Media Thickness in Dialysis Patients J. Am. Soc. Nephrol., November 1, 2001; 12(11): 2458 - 2464. [Abstract] [Full Text] [PDF]
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 J. A. Luchsinger, M.-X. Tang, Y. Stern, S. Shea, and R. Mayeux Diabetes Mellitus and Risk of Alzheimer's Disease and Dementia with Stroke in a Multiethnic Cohort Am. J. Epidemiol., October 1, 2001; 154(7): 635 - 641. [Abstract] [Full Text] [PDF]
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T.-C. Su, J.-S. Jeng, K.-L. Chien, F.-C. Sung, H.-C. Hsu, and Y.-T. Lee Hypertension Status Is the Major Determinant of Carotid Atherosclerosis: A Community-Based Study in Taiwan Stroke, October 1, 2001; 32(10): 2265 - 2271. [Abstract] [Full Text] [PDF]
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P. Amarenco Hypercholesterolemia, lipid-lowering agents, and the risk for brain infarction Neurology, September 1, 2001; 57(90002): S35 - 44. [Abstract] [Full Text]
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M. Zureik, F. Kauffmann, P.-J. Touboul, D. Courbon, and P. Ducimetiere Association Between Peak Expiratory Flow and the Development of Carotid Atherosclerotic Plaques Arch Intern Med, July 9, 2001; 161(13): 1669 - 1676. [Abstract] [Full Text] [PDF]
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J. I. Barzilay, C. F. Spiekerman, L. H. Kuller, G. L. Burke, V. Bittner, J. S. Gottdiener, F. L. Brancati, T. J. Orchard, D. H. O'Leary, and P. J. Savage Prevalence of Clinical and Isolated Subclinical Cardiovascular Disease in Older Adults With Glucose Disorders: The Cardiovascular Health Study Diabetes Care, July 1, 2001; 24(7): 1233 - 1239. [Abstract] [Full Text] [PDF]
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R. L. Sacco, R. T. Benson, D. E. Kargman, B. Boden-Albala, C. Tuck, I-F. Lin, J. F. Cheng, M. C. Paik, S. Shea, and L. Berglund High-Density Lipoprotein Cholesterol and Ischemic Stroke in the Elderly: The Northern Manhattan Stroke Study JAMA, June 6, 2001; 285(21): 2729 - 2735. [Abstract] [Full Text] [PDF]
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T. Mannami, T. Katsuya, S. Baba, N. Inamoto, K. Ishikawa, J. Higaki, T. Ogihara, and J. Ogata Low Potentiality of Angiotensin-Converting Enzyme Gene Insertion/Deletion Polymorphism as a Useful Predictive Marker for Carotid Atherogenesis in a Large General Population of a Japanese City : The Suita Study Stroke, June 1, 2001; 32(6): 1250 - 1256. [Abstract] [Full Text] [PDF]
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J Forsblad, A Gottsater, T Matzsch, and F Lindgarde Predictors of carotid endarterectomy in middle-aged individuals Vascular Medicine, May 1, 2001; 6(2): 81 - 85. [Abstract] [PDF]
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K. A. Matthews, L. H. Kuller, K. Sutton-Tyrrell, Y.-F. Chang, G. E. Tietjen, and R. L. Brey Changes in Cardiovascular Risk Factors During the Perimenopause and Postmenopause and Carotid Artery Atherosclerosis in Healthy Women Editorial Comment : Premenopausal Risk Continuum for Carotid Atherosclerosis After Menopause Stroke, May 1, 2001; 32(5): 1104 - 1111. [Abstract] [Full Text] [PDF]
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S. Homma, N. Hirose, H. Ishida, T. Ishii, G. Araki, and J. H. Halsey Jr Carotid Plaque and Intima-Media Thickness Assessed by B-Mode Ultrasonography in Subjects Ranging From Young Adults to Centenarians Editorial Comment Stroke, April 1, 2001; 32(4): 830 - 835. [Abstract] [Full Text] [PDF]
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L. B. Goldstein, R. Adams, K. Becker, C. D. Furberg, P. B. Gorelick, G. Hademenos, M. Hill, G. Howard, V. J. Howard, B. Jacobs, et al. Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association Circulation, January 2, 2001; 103(1): 163 - 182. [Full Text] [PDF]
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P.M. Rothwell The Interrelation between carotid, femoral and coronary artery disease Eur. Heart J., January 1, 2001; 22(1): 11 - 14. [PDF]
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S. Paterniti, M. Zureik, P. Ducimetiere, P.-J. Touboul, J.-M. Feve, and A. Alperovitch Sustained Anxiety and 4-Year Progression of Carotid Atherosclerosis Arterioscler Thromb Vasc Biol, January 1, 2001; 21(1): 136 - 141. [Abstract] [Full Text] [PDF]
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L. B. Goldstein, R. Adams, K. Becker, C. D. Furberg, P. B. Gorelick, G. Hademenos, M. Hill, G. Howard, V. J. Howard, B. Jacobs, et al. Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association Stroke, January 1, 2001; 32(1): 280 - 299. [Full Text] [PDF]
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 C. C. Phatouros, R. T. Higashida, A. M. Malek, P. M. Meyers, T. E. Lempert, C. F. Dowd, and V. V. Halbach Carotid Artery Stent Placement for Atherosclerotic Disease: Rationale, Technique, and Current Status Radiology, October 1, 2000; 217(1): 26 - 41. [Abstract] [Full Text]
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R. Barazzoni, M. Zanetti, G. Davanzo, E. Kiwanuka, P. Carraro, A. Tiengo, and P. Tessari Increased Fibrinogen Production in Type 2 Diabetic Patients without Detectable Vascular Complications: Correlation with Plasma Glucagon Concentrations J. Clin. Endocrinol. Metab., September 1, 2000; 85(9): 3121 - 3125. [Abstract] [Full Text]
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S. Takiuchi, H. Rakugi, K. Honda, T. Masuyama, N. Hirata, H. Ito, K. Sugimoto, Y. Yanagitani, K. Moriguchi, A. Okamura, et al. Quantitative Ultrasonic Tissue Characterization Can Identify High-Risk Atherosclerotic Alteration in Human Carotid Arteries Circulation, August 15, 2000; 102(7): 766 - 770. [Abstract] [Full Text] [PDF]
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P.-J. Touboul, A. Elbaz, C. Koller, C. Lucas, V. Adrai, F. Chedru, P. Amarenco, and f. t. G. Investigators Common Carotid Artery Intima-Media Thickness and Brain Infarction : The Etude du Profil Genetique de l'Infarctus Cerebral (GENIC) Case-Control Study Circulation, July 18, 2000; 102(3): 313 - 318. [Abstract] [Full Text] [PDF]
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C. Schmidt, J. Hulthe, J. Wikstrand, H. Gnarpe, J. Gnarpe, S. Agewall, and B. Fagerberg Chlamydia pneumoniae Seropositivity Is Associated With Carotid Artery Intima-Media Thickness Stroke, July 1, 2000; 31(7): 1526 - 1531. [Abstract] [Full Text] [PDF]
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M. Zureik, P. Ducimetiere, P.-J. Touboul, D. Courbon, C. Bonithon-Kopp, C. Berr, and C. Magne Common Carotid Intima-Media Thickness Predicts Occurrence of Carotid Atherosclerotic Plaques : Longitudinal Results From the Aging Vascular Study (EVA) Study Arterioscler Thromb Vasc Biol, June 1, 2000; 20(6): 1622 - 1629. [Abstract] [Full Text] [PDF]
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M. F. Muldoon, P. Nazzaro, K. Sutton-Tyrrell, and S. B. Manuck White-Coat Hypertension and Carotid Artery Atherosclerosis: A Matching Study Arch Intern Med, May 22, 2000; 160(10): 1507 - 1512. [Abstract] [Full Text] [PDF]
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 J. S. Jensen, B. Feldt-Rasmussen, S. Strandgaard, M. Schroll, and K. Borch-Johnsen Arterial Hypertension, Microalbuminuria, and Risk of Ischemic Heart Disease Hypertension, April 1, 2000; 35(4): 898 - 903. [Abstract] [Full Text] [PDF]
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E. Stensland-Bugge, K. H. Bonaa, O. Joakimsen, and I. Njolstad Sex Differences in the Relationship of Risk Factors to Subclinical Carotid Atherosclerosis Measured 15 Years Later : The Tromso Study Stroke, March 1, 2000; 31(3): 574 - 581. [Abstract] [Full Text] [PDF]
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B. Bülow, L. Hagmar, J. Eskilsson, and E. M. Erfurth Hypopituitary Females Have a High Incidence of Cardiovascular Morbidity and an Increased Prevalence of Cardiovascular Risk Factors J. Clin. Endocrinol. Metab., February 1, 2000; 85(2): 574 - 584. [Abstract] [Full Text]
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J. Willeit, S. Kiechl, F. Oberhollenzer, G. Rungger, G. Egger, E. Bonora, M. Mitterer, and M. Muggeo Distinct Risk Profiles of Early and Advanced Atherosclerosis : Prospective Results From the Bruneck Study Arterioscler Thromb Vasc Biol, February 1, 2000; 20(2): 529 - 537. [Abstract] [Full Text] [PDF]
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P. Greenland, J. Abrams, G. P. Aurigemma, M. G. Bond, L. T. Clark, M. H. Criqui, J. R. Crouse III, L. Friedman, V. Fuster, D. M. Herrington, et al. Prevention Conference V : Beyond Secondary Prevention : Identifying the High-Risk Patient for Primary Prevention : Noninvasive Tests of Atherosclerotic Burden : Writing Group III Circulation, January 4, 2000; 101 (1): e16 - e22. [Full Text] [PDF]
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O. Joakimsen, K. H. Bonaa, E. Stensland-Bugge, and B. K. Jacobsen Age and Sex Differences in the Distribution and Ultrasound Morphology of Carotid Atherosclerosis : The Tromso Study Arterioscler Thromb Vasc Biol, December 1, 1999; 19(12): 3007 - 3013. [Abstract] [Full Text] [PDF]
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P. S. Saba, M. J. Roman, C. Longhini, D. Scorzoni, R. Pini, R. B. Devereux, and A. Ganau Carotid Intimal-Medial Thickness and Stiffness Are Not Affected by Hypercholesterolemia in Uncomplicated Essential Hypertension Arterioscler Thromb Vasc Biol, November 1, 1999; 19(11): 2788 - 2794. [Abstract] [Full Text] [PDF]
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S. M. Grundy, I. J. Benjamin, G. L. Burke, A. Chait, R. H. Eckel, B. V. Howard, W. Mitch, S. C. Smith Jr, and J. R. Sowers Diabetes and Cardiovascular Disease : A Statement for Healthcare Professionals From the American Heart Association Circulation, September 7, 1999; 100(10): 1134 - 1146. [Full Text] [PDF]
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